Basic Information
| Provider Information | |||||||||
| NPI: | 1134168925 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | WARREN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.D., PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11209 N TATUM BLVD | ||||||||
| Address2: | SUITE 180 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850283091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024945155 | ||||||||
| FaxNumber: | 6024945115 | ||||||||
| Practice Location | |||||||||
| Address1: | 11209 N TATUM BLVD | ||||||||
| Address2: | SUITE 180 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850283091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024945155 | ||||||||
| FaxNumber: | 6024945115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 23569 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.