Provider Demographics
NPI:1881953578
Name:JOHNSON, MARK JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JOSEPH
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 1:2810 N SWAN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6300
Mailing Address - Country:US
Mailing Address - Phone:520-324-2030
Mailing Address - Fax:520-445-6019
Practice Address - Street 1:2810 N SWAN RD STE 1002810N
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6305
Practice Address - Country:US
Practice Address - Phone:520-324-2030
Practice Address - Fax:520-445-6019
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-00200207L00000X
AZ53668207L00000X
AZR73208207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine