Provider Demographics
NPI:1518057603
Name:JOHNSON, DAVID RODRIC (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RODRIC
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10619 N HAYDEN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-8510
Mailing Address - Country:US
Mailing Address - Phone:480-948-0733
Mailing Address - Fax:480-443-5611
Practice Address - Street 1:10619 N HAYDEN RD STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-8510
Practice Address - Country:US
Practice Address - Phone:480-948-0733
Practice Address - Fax:480-443-5611
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10913207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD44075Medicare UPIN