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General NPI Number Information
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NPI Number | 1285619072
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Entity Type | Individual
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Provider Name | RUTH ANN JOHNSON MD
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Gender | Female
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 13500 BROADWAY ST
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City | ALDEN
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State | NY
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Zip | 14004-1417
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Country | US
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Telephone | 716-937-6743
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Fax | 716-937-6453
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Provider Business Mailing Address
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Address Line | 13500 BROADWAY ST
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City | ALDEN
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State | NY
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Zip | 14004-1417
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Country | US
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Telephone | 716-937-6743
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Fax | 716-937-6453
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 165174
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License Number State | NY
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