MEDICARE: DR. STEVEN B JOHNSON M.D.

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	174400000X	Specialist	D0057842	MD
2	2086S0102X	Surgical Critical Care Physician	D0057842	MD
3	208600000X	Surgery Physician	D0057842	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336112374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN B JOHNSON M.D.

Provider Business Mailing Address
First Line	:	1441 N 12TH ST FL 1
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2837
Country	:	US
Telephone Number	:	602-521-5968
Fax Number	:	602-521-5988

Provider Business Practice Location Address
First Line	:	1441 N 12TH ST FL 1
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2837
Country	:	US
Telephone Number	:	602-521-5968
Fax Number	:	602-521-5988

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

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	12/14/2017

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