Healthcare Provider Details

I. General information

NPI: 1912879198
Provider Name (Legal Business Name): ALEX J JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 CLOVER DR SW
CEDAR RAPIDS IA
52404-4632
US

IV. Provider business mailing address

1419 SALT SPRINGS RD DEPT SYRACUSE
SYRACUSE NY
13214-1300
US

V. Phone/Fax

Practice location:
  • Phone: 319-777-4831
  • Fax:
Mailing address:
  • Phone: 319-777-4831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: