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General NPI Number Information
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NPI Number | 1962959767
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Entity Type | Organization
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Legal Business Name | EM MEDICAL MANAGEMENT OF FORT MOHAVE, LLC
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Dates
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Enumeration Date | 09/08/2016
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Last Update Date | 09/09/2016
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Provider Practice Location Address
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Address Line | 5330 S HIGHWAY 95
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City | FORT MOHAVE
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State | AZ
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Zip | 86426-9225
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Country | US
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Telephone | 928-788-7069
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Fax |
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Provider Business Mailing Address
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Address Line | 307 W ALAMOSA DR
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City | CHANDLER
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State | AZ
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Zip | 85248-5303
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | FREDERICK JOHNSON
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Credential | MD
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Telephone | 219-629-0453
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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 |
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License Number State |
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