Basic Information
| Provider Information | |||||||||
| NPI: | 1093775942 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1441 N 12TH ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024954577 | ||||||||
| FaxNumber: | 6024173549 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 EDISON ST | ||||||||
| Address2: | |||||||||
| City: | BRUSH | ||||||||
| State: | CO | ||||||||
| PostalCode: | 807231642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708426200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 08/06/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 23245 | CO | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 23245 | CO | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.