Provider Demographics
NPI:1598659815
Name:JOHNSON, ALEC RONALD (PA-C)
Entity type:Individual
Prefix:MR
First Name:ALEC
Middle Name:RONALD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2380 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-2143
Mailing Address - Country:US
Mailing Address - Phone:517-742-4922
Mailing Address - Fax:877-850-9046
Practice Address - Street 1:2380 CEDAR ST
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-2143
Practice Address - Country:US
Practice Address - Phone:517-742-4922
Practice Address - Fax:877-850-9046
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601013345363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant