Basic Information
| Provider Information | |||||||||
| NPI: | 1568554871 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | SHELDON | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4950 ESSEN LANE | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708093482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252151311 | ||||||||
| FaxNumber: | 2252151380 | ||||||||
| Practice Location | |||||||||
| Address1: | 4950 ESSEN LANE | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708093482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257670847 | ||||||||
| FaxNumber: | 2257661417 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 12/21/2009 | ||||||||
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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 | 2085R0001X | 04300R | LA | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0203X | 04300R | LA | Y | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1313459 | 05 | LA | MEDICAID |