Physician Compare National (NPI:1326157298)

HEALTHCARE PROVIDER: GLEN ERIC JOHNSON MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1326157298
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7214116698
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110201000720
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	JOHNSON
	Individual professional last name
Provider First Name	GLEN
	Individual professional first name
Provider Middle Name	E
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF WISCONSIN SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1971
	Individual professional's medical school graduation year
Primary Specialty	PSYCHIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	3940 W 4100
	Group Practice or individual's line 1 address
City	WEST VALLEY CITY
	Group Practice or individual's city
State	UT
	Group Practice or individual's state
Zip Code	841205450
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M