MEDICARE: DR. DAVID H 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	207Q00000X	Family Medicine Physician	0101-231013	VA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508837741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID H JOHNSON MD

Provider Business Mailing Address
First Line	:	5814 CAVALIER DR
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-3870
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18080 MAIN ST
Second Line	:
City	:	BUCHANAN
State	:	VA
Zip	:	24066-5482
Country	:	US
Telephone Number	:	540-254-1239
Fax Number	:

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

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	05/20/2008

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