Healthcare Provider Details

I. General information

NPI: 1447221031
Provider Name (Legal Business Name): JEREMY N JOHNSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N MAIN
LOCKNEY TX
79241
US

IV. Provider business mailing address

20 PINE CT
PLACITAS NM
87043-9131
US

V. Phone/Fax

Practice location:
  • Phone: 806-652-3373
  • Fax:
Mailing address:
  • Phone: 808-895-9420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA-2434-20
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberN6394
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: