Healthcare Provider Details

I. General information

NPI: 1417118217
Provider Name (Legal Business Name): GARY MICHAEL JOHNSON II AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N 87TH ST
SCOTTSDALE AZ
85257-2922
US

IV. Provider business mailing address

1625 N 87TH ST
SCOTTSDALE AZ
85257-2922
US

V. Phone/Fax

Practice location:
  • Phone: 480-429-0026
  • Fax: 480-429-0028
Mailing address:
  • Phone: 480-429-0026
  • Fax: 480-429-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberDA5875
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberDA5875
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: