Healthcare Provider Details

I. General information

NPI: 1912896473
Provider Name (Legal Business Name): CRAIG H JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 CAMINO DEL SOL
SANTA FE NM
87508-8146
US

IV. Provider business mailing address

6 CAMINO DEL SOL
SANTA FE NM
87508-8146
US

V. Phone/Fax

Practice location:
  • Phone: 505-984-3295
  • Fax:
Mailing address:
  • Phone: 505-984-3295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number94-275
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: