MEDICARE: DEREK BRENT JOHNSON D.O.

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	207L00000X	Anesthesiology Physician	359058-1204	UT
2	390200000X	Student in an Organized Health Care Education/Training Program	2006018684	MO

General Provider Information

NPI Number	:	1962605857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK BRENT JOHNSON D.O.

Provider Business Mailing Address
First Line	:	3136 LOWER SADDLEBACK RD
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-4829
Country	:	US
Telephone Number	:	801-707-7423
Fax Number	:

Provider Business Practice Location Address
First Line	:	5121 S COTTONWOOD STREET
Second Line	:	INTERMOUNTAIN MEDICAL CENTER
City	:	MURRAY
State	:	UT
Zip	:	84157-2520
Country	:	US
Telephone Number	:	801-507-5248
Fax Number	:

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

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	01/09/2012

Similar Medicare Providers

1447443825 — MEGAN JAKUB
Practice Location Address:

4007 WASHINGTON RD
MC MURRAY, PA
15317-2520

Practice Phone: 724-941-0788
Practice Fax:

1407097504 — GIANT EAGLE INC
Practice Location Address:

4007 WASHINGTON RD , DONALDSONS CROSSROADS
MC MURRAY, PA
15317-2520

Practice Phone: 724-941-5100
Practice Fax: 724-941-5380

1053541342 — EYE CANDY OPTICAL CENTER
Practice Location Address:

4007 WASHINGTON RD , DONALDSON'S CROSSROADS
MC MURRAY, PA
15317-2520

Practice Phone: 724-941-5100
Practice Fax: 724-941-5380

1386966653 — MR. JEFFREY EUGENE ROTH RPH
Practice Location Address:

4041 WASHINGTON RD
MC MURRAY, PA
15317-2520

Practice Phone: 724-942-4927
Practice Fax:

1528338027 — MRS. SAMANTHA MASTERS MONTGOMERY MS, RD, LDN
Practice Location Address:

4007 WASHINGTON RD
MC MURRAY, PA
15317-2520

Practice Phone: 724-941-7220
Practice Fax:

1710914015 — TODD CHARLES SEYMOUR MD
Practice Location Address:

5121 S COTTONWOOD STREET , INTERMOUNTAIN MEDICAL CENTER
MURRAY, UT
84157

Practice Phone: 801-507-5248
Practice Fax: 541-773-2027

Directions to “ DEREK BRENT JOHNSON D.O.” 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.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.