Healthcare Provider Details

I. General information

NPI: 1710963681
Provider Name (Legal Business Name): STEVEN JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 DEBARR RD STE 310
ANCHORAGE AK
99508-6804
US

IV. Provider business mailing address

2751 DEBARR RD STE 310
ANCHORAGE AK
99508-6804
US

V. Phone/Fax

Practice location:
  • Phone: 907-563-2873
  • Fax: 907-563-5852
Mailing address:
  • Phone: 907-563-2873
  • Fax: 907-563-5852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4476
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMEDS6318
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: