Provider Demographics
NPI:1508824871
Name:JOHNSON, CHRISTOPHER S (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:S
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2708 RIFE MEDICAL LANE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1452
Mailing Address - Country:US
Mailing Address - Phone:479-338-5555
Mailing Address - Fax:479-338-5533
Practice Address - Street 1:2708 RIFE MEDICAL LANE
Practice Address - Street 2:SUITE 130
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1452
Practice Address - Country:US
Practice Address - Phone:479-338-5555
Practice Address - Fax:479-338-5533
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2011-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARC-7489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR118727001Medicaid
AR118727001Medicaid
ARE73307Medicare UPIN