Provider Demographics
NPI:1437181351
Name:JOHNSON, TIM D (MD)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6220 PERKINS ROAD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4120
Mailing Address - Country:US
Mailing Address - Phone:225-768-7777
Mailing Address - Fax:225-214-3400
Practice Address - Street 1:6220 PERKINS ROAD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4120
Practice Address - Country:US
Practice Address - Phone:225-768-7777
Practice Address - Fax:225-214-3400
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016429174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1361101Medicaid
LAB62866Medicare UPIN
LA51188Medicare ID - Type Unspecified
LA5C951Medicare ID - Type UnspecifiedGROUP NUMBER