Basic Information
| Provider Information | |||||||||
| NPI: | 1568596229 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | ANDREW | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 925 IRONWOOD DR | ||||||||
| Address2: | SUITE 2105 | ||||||||
| City: | MINDEN | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894235178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7754457745 | ||||||||
| FaxNumber: | 7757820073 | ||||||||
| Practice Location | |||||||||
| Address1: | 925 IRONWOOD DRIVE | ||||||||
| Address2: | SUITE 2105 | ||||||||
| City: | MINDEN | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894235180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7752833096 | ||||||||
| FaxNumber: | 7752833091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 10/10/2013 | ||||||||
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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 | 207Q00000X | 12752 | NV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.