Healthcare Provider Details

I. General information

NPI: 1467428722
Provider Name (Legal Business Name): THOMAS C JOHNSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 5TH ST
ELKO NV
89801-3202
US

IV. Provider business mailing address

900 5TH ST
ELKO NV
89801-3202
US

V. Phone/Fax

Practice location:
  • Phone: 775-738-7455
  • Fax: 775-738-7478
Mailing address:
  • Phone: 775-738-7455
  • Fax: 775-738-7478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number912
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: