Healthcare Provider Details

I. General information

NPI: 1376998294
Provider Name (Legal Business Name): DREW CARTER JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N CAMPBELL AVE RM 3301
TUCSON AZ
85719-4330
US

IV. Provider business mailing address

1625 N CAMPBELL AVE RM 3301
TUCSON AZ
85719-4330
US

V. Phone/Fax

Practice location:
  • Phone: 520-626-7944
  • Fax:
Mailing address:
  • Phone: 520-626-7944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR75535
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: