Provider Demographics
NPI:1518123041
Name:JOHNSON, STEVEN WESLEY (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:WESLEY
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:PO BOX 2925
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98907-2925
Mailing Address - Country:US
Mailing Address - Phone:509-248-6633
Mailing Address - Fax:509-248-0178
Practice Address - Street 1:315 HOLTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3254
Practice Address - Country:US
Practice Address - Phone:509-248-6633
Practice Address - Fax:509-248-0178
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE57572085R0202X
AZ457522085R0202X
HIMD-238972085R0202X
WAMD603353452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ722326Medicaid
AZZ155030Medicare PIN