Provider Demographics
NPI:1700848330
Name:JOHNSON, STEPHEN KRAIG (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:KRAIG
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 1:2010 BROOKWOOD MEDICAL CTR DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6804
Mailing Address - Country:US
Mailing Address - Phone:205-655-7830
Mailing Address - Fax:205-655-7839
Practice Address - Street 1:2010 BROOKWOOD MEDICAL CTR DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6804
Practice Address - Country:US
Practice Address - Phone:205-877-1930
Practice Address - Fax:205-877-1865
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00010139207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051039549OtherBLUE CROSS/BLUE SHIELD
AL000039549Medicaid
ALC72434Medicare UPIN
AL000039549Medicare ID - Type Unspecified