Healthcare Provider Details

I. General information

NPI: 1487999033
Provider Name (Legal Business Name): TIMOTHY JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 N TELSHOR BLVD STE A
LAS CRUCES NM
88011-8279
US

IV. Provider business mailing address

920 N TELSHOR BLVD STE A
LAS CRUCES NM
88011-8279
US

V. Phone/Fax

Practice location:
  • Phone: 575-526-3277
  • Fax: 575-522-0026
Mailing address:
  • Phone: 575-526-3277
  • Fax: 575-522-0026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: