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General NPI Number Information
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NPI Number | 1114120896
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Entity Type | Individual
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Provider Name | KEVIN R JOHNSON DO
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Gender | Male
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Dates
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Enumeration Date | 06/08/2007
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Last Update Date | 03/15/2021
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Provider Practice Location Address
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Address Line | 1111 E MCDOWELL RD
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City | PHOENIX
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State | AZ
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Zip | 85006-2612
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Country | US
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Telephone | 602-839-6968
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Fax | 602-839-4144
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Provider Business Mailing Address
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Address Line | 645 E MISSOURI AVE STE 300
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City | PHOENIX
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State | AZ
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Zip | 85012-1351
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Country | US
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Telephone | 480-500-2540
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Fax | 623-201-7954
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 005192
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License Number State | AZ
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