Healthcare Provider Details

I. General information

NPI: 1063328656
Provider Name (Legal Business Name): LTM JOHNSON MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CORONADO CENTER DR STE 200
HENDERSON NV
89052-4291
US

IV. Provider business mailing address

2657 WINDMILL PKWY # 141
HENDERSON NV
89074-3384
US

V. Phone/Fax

Practice location:
  • Phone: 725-356-6593
  • Fax: 702-725-7068
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ELIJAH JOHNSON
Title or Position: OWNER/OPERATOR
Credential: MD
Phone: 702-334-0145