Provider Demographics
NPI:1598835167
Name:JOHNSON, MARGERY R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGERY
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E PUSCH WILDERNESS DR UNIT 3102
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-6027
Mailing Address - Country:US
Mailing Address - Phone:520-591-5413
Mailing Address - Fax:520-595-3466
Practice Address - Street 1:1500 E PUSCH WILDERNESS DR UNIT 3102
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-6027
Practice Address - Country:US
Practice Address - Phone:520-591-5413
Practice Address - Fax:520-595-3466
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ592562084P0800X
MDD00931832084P0800X
VA01012741992084P0800X
IL0360631182084P0804X
CA1728332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036063118Medicaid
ILE18545Medicare UPIN