Provider Demographics
NPI:1609802545
Name:JOHNSON, STEVEN (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
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 1:13331 FAIRWAY CT
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-9682
Mailing Address - Country:US
Mailing Address - Phone:479-524-4773
Mailing Address - Fax:
Practice Address - Street 1:13331 FAIRWAY CT
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-9682
Practice Address - Country:US
Practice Address - Phone:479-238-1222
Practice Address - Fax:479-238-1229
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3034207Q00000X
ARR4430207Q00000X
MO2000167443207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100251340BMedicaid
AR124617003Medicaid
MO1609802545Medicaid
OK100251340BMedicaid
AR5J317G180Medicare PIN