Provider Demographics
NPI:1134188956
Name:JOHNSON, MARK EVERETT BRADFORD (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:EVERETT BRADFORD
Last Name:JOHNSON
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Gender:M
Credentials:MD, MBA
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Mailing Address - Street 1:16620 N 40TH ST
Mailing Address - Street 2:STE I-5
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3348
Mailing Address - Country:US
Mailing Address - Phone:602-482-1300
Mailing Address - Fax:480-718-7342
Practice Address - Street 1:16620 N 40TH ST
Practice Address - Street 2:STE I-5
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3348
Practice Address - Country:US
Practice Address - Phone:602-482-1300
Practice Address - Fax:480-718-7342
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2011-04-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ24917207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology