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General NPI Number Information
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NPI Number | 1710071493
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Entity Type | Individual
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Provider Name | STAFFAN C JOHNSSON MD
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 02/08/2026
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Provider Practice Location Address
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Address Line | 1034 N 500 W
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City | PROVO
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State | UT
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Zip | 84604
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Country | US
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Telephone | 801-993-9582
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Fax | 801-733-5618
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Provider Business Mailing Address
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Address Line | 2975 W EXECUTIVE PKWY 200
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City | LEHI
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State | UT
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Zip | 84043
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Country | US
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Telephone | 801-990-1911
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Fax | 801-990-1912
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 78-163256-1205
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License Number State | UT
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