Healthcare Provider Details

I. General information

NPI: 1104880830
Provider Name (Legal Business Name): ARTHUR ALLEN JOHNSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 W ELLIOT RD SUITE 102
GILBERT AZ
85233-5102
US

IV. Provider business mailing address

20926 N LAUREN RD
MARICOPA AZ
85138-6881
US

V. Phone/Fax

Practice location:
  • Phone: 480-545-2787
  • Fax: 919-882-9575
Mailing address:
  • Phone: 520-313-3121
  • Fax: 919-882-9575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3189
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3189
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: