Healthcare Provider Details

I. General information

NPI: 1174597058
Provider Name (Legal Business Name): DAVID HOWARD JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 IRONWOOD DRIVE SUITE 2103
MINDEN NV
89423-5180
US

IV. Provider business mailing address

2874 N. CARSON STREET SUITE 200
CARSON CITY NV
89706-1682
US

V. Phone/Fax

Practice location:
  • Phone: 775-445-7885
  • Fax: 775-783-9550
Mailing address:
  • Phone: 775-283-3096
  • Fax: 775-283-3096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4143
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4143
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: