MEDICARE: DR. DWIGHT JOSEPH JOHNSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	E6191	AR
2	207Q00000X	Family Medicine Physician	M1800	TX
3	207Q00000X	Family Medicine Physician	D61970	MD
4	207Q00000X	Family Medicine Physician	E6191	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134106743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DWIGHT JOSEPH JOHNSON MD

Provider Business Mailing Address
First Line	:	11001 EXECUTIVE CENTER DR STE 200
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-4393
Country	:	US
Telephone Number	:	479-709-7250
Fax Number	:	479-709-7251

Provider Business Practice Location Address
First Line	:	6100 MASSARD RD
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72916-8886
Country	:	US
Telephone Number	:	479-709-7250
Fax Number	:	479-709-7251

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	02/24/2025

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