Healthcare Provider Details

I. General information

NPI: 1891750758
Provider Name (Legal Business Name): TAMARA JOY JOHNSON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6285 S HIGLEY RD
GILBERT AZ
85298-4262
US

IV. Provider business mailing address

6285 S HIGLEY RD
GILBERT AZ
85298-4262
US

V. Phone/Fax

Practice location:
  • Phone: 480-460-4949
  • Fax: 480-460-5858
Mailing address:
  • Phone: 480-460-4949
  • Fax: 480-460-5858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number006839
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: