Provider Demographics
NPI:1851307276
Name:JOHNSON, EUGENE WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:WILLIAM
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 70232
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-0030
Mailing Address - Country:US
Mailing Address - Phone:520-395-0512
Mailing Address - Fax:520-505-4108
Practice Address - Street 1:5860 N LA CHOLLA BLVD STE 150
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3562
Practice Address - Country:US
Practice Address - Phone:520-395-0512
Practice Address - Fax:520-505-4108
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34986208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ347495Medicaid
AZZ135695Medicare PIN