Healthcare Provider Details

I. General information

NPI: 1376838110
Provider Name (Legal Business Name): LINDA L. JOHNSON MD, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 07/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E LAKE MEAD PKWY
HENDERSON NV
89015-5576
US

IV. Provider business mailing address

2720 N TENAYA WAY
LAS VEGAS NV
89128-0424
US

V. Phone/Fax

Practice location:
  • Phone: 702-560-2915
  • Fax:
Mailing address:
  • Phone: 702-560-2889
  • Fax: 702-560-2928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number StateNV

VIII. Authorized Official

Name: LINDA L JOHNSON
Title or Position: SMA PRESIDENT
Credential:
Phone: 702-560-2886