Provider Demographics
NPI:1023165487
Name:JOHNSON, STEMPLE D (MD)
Entity type:Individual
Prefix:
First Name:STEMPLE
Middle Name:D
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 1:331 MAINE ST
Mailing Address - Street 2:SUITE 23
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3358
Mailing Address - Country:US
Mailing Address - Phone:207-729-0134
Mailing Address - Fax:207-729-6626
Practice Address - Street 1:331 MAINE ST
Practice Address - Street 2:SUITE 23
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3358
Practice Address - Country:US
Practice Address - Phone:207-729-0134
Practice Address - Fax:207-729-6626
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME12197208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME338440099Medicaid
MM7286Medicare PIN
A89761Medicare UPIN