Provider Demographics
NPI:1912948928
Name:JOHNSON, CLIFTON R (MD)
Entity Type:Individual
Prefix:
First Name:CLIFTON
Middle Name:R
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 1:5800 W 10TH ST
Mailing Address - Street 2:SUITE 610 FREEWAY MEDICAL CENTER
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204
Mailing Address - Country:US
Mailing Address - Phone:501-661-9393
Mailing Address - Fax:501-663-4795
Practice Address - Street 1:5800 W 10TH ST
Practice Address - Street 2:SUITE 610 FREEWAY MEDICAL CENTER
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204
Practice Address - Country:US
Practice Address - Phone:501-661-9393
Practice Address - Fax:501-663-4795
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7709207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5K101Medicare ID - Type Unspecified
F27467Medicare UPIN