Provider Demographics
NPI:1497069868
Name:JOHNSON, ROBERT ERNEST (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ERNEST
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7664 WILLIAM CIR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-3717
Mailing Address - Country:US
Mailing Address - Phone:801-808-2213
Mailing Address - Fax:
Practice Address - Street 1:6020 W PARKER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8171
Practice Address - Country:US
Practice Address - Phone:972-608-5000
Practice Address - Fax:972-608-5020
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ4148207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery