Healthcare Provider Details

I. General information

NPI: 1427053867
Provider Name (Legal Business Name): JARROD D JOHNSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

I15 EXIT 9 @ THE FIRESTATION
LITTLEFIELD AZ
86432-0490
US

IV. Provider business mailing address

PO BOX 490
LITTLEFIELD AZ
86432-0490
US

V. Phone/Fax

Practice location:
  • Phone: 928-347-5971
  • Fax: 928-347-5793
Mailing address:
  • Phone: 928-347-5971
  • Fax: 928-347-5793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4092
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: