Provider Demographics
NPI:1205939089
Name:JOHNSON, CURTIS C (MD)
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:C
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 1:1055 N 500 W
Mailing Address - Street 2:CREDENTIALING DEPARTMENT
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:1055 N 500 W STE 207
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3305
Practice Address - Country:US
Practice Address - Phone:801-375-4263
Practice Address - Fax:801-429-8085
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT296076-1205207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870281028000Medicaid
UT09-00166OtherUTAH HEALTHCARE
UT107007657102OtherIHC
UT68079OtherPEHP
UT870281028CUROtherEMIA
UT228569OtherDMBA
UTQM000056633OtherALTIUS
UT200045126OtherPALMETTO
UT09-00166OtherUTAH HEALTHCARE
UT228569OtherDMBA
UTQM000056633OtherALTIUS