Provider Demographics
NPI:1962443622
Name:JOHNS, GREGORY J (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:JOHNS
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 1:4400 N 32ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3965
Mailing Address - Country:US
Mailing Address - Phone:602-522-1900
Mailing Address - Fax:602-381-3281
Practice Address - Street 1:4400 N 32ND ST STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3965
Practice Address - Country:US
Practice Address - Phone:602-522-1900
Practice Address - Fax:602-381-3281
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22763207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ320292Medicaid
AZZ23126Medicare PIN
AZ320292Medicaid
AZ23126Medicare ID - Type Unspecified