Healthcare Provider Details

I. General information

NPI: 1912948928
Provider Name (Legal Business Name): CLIFTON R JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 W 10TH ST SUITE 610 FREEWAY MEDICAL CENTER
LITTLE ROCK AR
72204
US

IV. Provider business mailing address

5800 W 10TH ST SUITE 610 FREEWAY MEDICAL CENTER
LITTLE ROCK AR
72204
US

V. Phone/Fax

Practice location:
  • Phone: 501-661-9393
  • Fax: 501-663-4795
Mailing address:
  • Phone: 501-661-9393
  • Fax: 501-663-4795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberC7709
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: