Healthcare Provider Details

I. General information

NPI: 1194917641
Provider Name (Legal Business Name): AARON JOHNSON MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 PROVIDENCE DR PROVIDENCE ALASKA MED CTR.
ANCHORAGE AK
99508-4615
US

IV. Provider business mailing address

2440 E TUDOR RD #175
ANCHORAGE AK
99507-1185
US

V. Phone/Fax

Practice location:
  • Phone: 907-261-3650
  • Fax:
Mailing address:
  • Phone: 907-727-9393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number5036
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number5036
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number5036
License Number StateAK

VIII. Authorized Official

Name: AARON PATRICK JOHNSON
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 907-727-9393