Healthcare Provider Details

I. General information

NPI: 1407825045
Provider Name (Legal Business Name): ROBERT L JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18699 N 67TH AVE SUITE 310
GLENDALE AZ
85308-7140
US

IV. Provider business mailing address

6301 S MCCLINTOCK DR SUITE 115
TEMPE AZ
85283-3392
US

V. Phone/Fax

Practice location:
  • Phone: 623-362-2266
  • Fax: 623-362-2412
Mailing address:
  • Phone: 480-897-0242
  • Fax: 480-897-0244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number17150
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: