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1306892542

NPI Code Detail

MEDICARE: MICHAEL EUGENE JOHNSON MD

MEDICARE: MICHAEL EUGENE JOHNSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	E2802	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00285103	OTHER	AR	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5L772	OTHER	AR	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306892542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL EUGENE JOHNSON MD

Provider Business Mailing Address
First Line	:	PO BOX 24086
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76124-1086
Country	:	US
Telephone Number	:	817-451-4208
Fax Number	:

Provider Business Practice Location Address
First Line	:	1520 N DIVISION ST
Second Line	:
City	:	BLYTHEVILLE
State	:	AR
Zip	:	72315-1448
Country	:	US
Telephone Number	:	870-838-7460
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	07/02/2008

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Directions to “ MICHAEL EUGENE JOHNSON MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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