Provider Demographics
NPI:1932204807
Name:JOHNSON, TODD W (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:W
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:PO BOX 765
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-0765
Mailing Address - Country:US
Mailing Address - Phone:435-613-1333
Mailing Address - Fax:
Practice Address - Street 1:300 N HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-4218
Practice Address - Country:US
Practice Address - Phone:800-748-4868
Practice Address - Fax:801-733-5872
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT360756-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107003518102OtherIHC
UT65785OtherPEHP
UTQM0000076612OtherALTIUS
UT38891OtherHEALTHY U
UT2000575OtherUNITED HEALTHCARE
UTTPRA10930OtherMOLINA
UT683628OtherDESERET MUTUAL
UT65785OtherPEHP