Healthcare Provider Details

I. General information

NPI: 1407184930
Provider Name (Legal Business Name): DENISE L JOHNSON DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 06/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 HOUMA BLVD BUILDING 6, SUITE 224
METAIRIE LA
70006-2931
US

IV. Provider business mailing address

3939 HOUMA BLVD BUILDING 6, SUITE 224
METAIRIE LA
70006-2931
US

V. Phone/Fax

Practice location:
  • Phone: 504-454-2900
  • Fax: 504-454-2915
Mailing address:
  • Phone: 504-454-2900
  • Fax: 504-454-2915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDPM.200051
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: