Provider Demographics
NPI:1710963681
Name:JOHNSON, STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
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 1:2751 DEBARR RD
Mailing Address - Street 2:STE 310
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-6804
Mailing Address - Country:US
Mailing Address - Phone:907-563-2873
Mailing Address - Fax:907-563-5852
Practice Address - Street 1:2751 DEBARR RD
Practice Address - Street 2:STE 310
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-6804
Practice Address - Country:US
Practice Address - Phone:907-563-2873
Practice Address - Fax:907-563-5852
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKMEDS6318208VP0014X
NV4476207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002094Medicaid
NV002002094Medicaid
NVV104384Medicare PIN