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NPI Code Detail

MEDICARE: DR. BRADLEY W JOHNSON D.O

MEDICARE: DR. BRADLEY W JOHNSON D.O
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
1207Q00000XFamily Medicine Physician4136IA

General Provider Information

NPI Number : 1134116684
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRADLEY W JOHNSON D.O
Provider Business Mailing Address
First Line : 1345 W CENTRAL PARK AVE
Second Line :
City : DAVENPORT
State : IA
Zip : 52804-1844
Country : US
Telephone Number : 563-421-4400
Fax Number : 563-421-4449
Provider Business Practice Location Address
First Line : 1345 W CENTRAL PARK AVE
Second Line :
City : DAVENPORT
State : IA
Zip : 52804-1844
Country : US
Telephone Number : 563-421-4400
Fax Number : 563-421-4449
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2005
Last Update Date : 04/20/2021

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