Healthcare Provider Details

I. General information

NPI: 1265963425
Provider Name (Legal Business Name): ALISON BRANDEIS JOHNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3903 MEDICAL DR STE 100
OGDEN UT
84403-2316
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-8900
  • Fax:
Mailing address:
  • Phone: 865-305-9006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number14224226-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: