=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588820864
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRENT D JOHNSON M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2008
-----------------------------------------------------
Last Update Date | 12/30/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1900 MALVERN AVE SUITE 301
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71901-7759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-321-0555
-----------------------------------------------------
Fax | 501-623-1521
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 389 LAKE HAMILTON DR A14
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71913-6899
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-551-1195
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | KY44444
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | E7244
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------