Healthcare Provider Details

I. General information

NPI: 1528047214
Provider Name (Legal Business Name): GALEN JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10240 W INDIAN SCHOOL RD BUILDING 2 STE 140
PHOENIX AZ
85037-5904
US

IV. Provider business mailing address

10240 W INDIAN SCHOOL RD BUILDING 2 STE 140
PHOENIX AZ
85037-5904
US

V. Phone/Fax

Practice location:
  • Phone: 623-846-7558
  • Fax: 623-846-1674
Mailing address:
  • Phone: 623-846-7558
  • Fax: 623-846-1674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number19218
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: