Provider Demographics
NPI:1972736981
Name:DAVID C JOHNSON MD PC
Entity Type:Organization
Organization Name:DAVID C JOHNSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANANGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-219-2280
Mailing Address - Street 1:20950 N TATUM BLVD
Mailing Address - Street 2:SUITE 380
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4200
Mailing Address - Country:US
Mailing Address - Phone:480-419-2280
Mailing Address - Fax:480-219-2290
Practice Address - Street 1:20950 N TATUM BLVD
Practice Address - Street 2:SUITE 380
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4200
Practice Address - Country:US
Practice Address - Phone:480-419-2280
Practice Address - Fax:480-219-2290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14158208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty