MEDICARE: ERIC P JOHNSON PAC

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	363AM0700X	Medical Physician Assistant	3398	AZ

General Provider Information

NPI Number	:	1932124435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC P JOHNSON PAC

Provider Business Mailing Address
First Line	:	3514 N POWER RD STE 118
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85215-2909
Country	:	US
Telephone Number	:	480-844-8346
Fax Number	:	480-889-6997

Provider Business Practice Location Address
First Line	:	3514 N POWER ROAD
Second Line	:	SUITE 118
City	:	MESA
State	:	AZ
Zip	:	85215-2909
Country	:	US
Telephone Number	:	480-844-8346
Fax Number	:	480-889-6997

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	05/05/2015

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Directions to “ ERIC P JOHNSON PAC” Practice Location

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