MEDICARE: ROBERT L 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	207VM0101X	Maternal & Fetal Medicine Physician	17150	AZ

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	:	1407825045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT L JOHNSON M.D.

Provider Business Mailing Address
First Line	:	6301 S MCCLINTOCK DR
Second Line	:	SUITE 115
City	:	TEMPE
State	:	AZ
Zip	:	85283-3392
Country	:	US
Telephone Number	:	480-897-0242
Fax Number	:	480-897-0244

Provider Business Practice Location Address
First Line	:	18699 N 67TH AVE
Second Line	:	SUITE 310
City	:	GLENDALE
State	:	AZ
Zip	:	85308-7140
Country	:	US
Telephone Number	:	623-362-2266
Fax Number	:	623-362-2412

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	07/09/2007

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