MEDICARE: DR. MARK EVERETT BRADFORD JOHNSON MD, MBA

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	24917	AZ

General Provider Information

NPI Number	:	1134188956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK EVERETT BRADFORD JOHNSON MD, MBA

Provider Business Mailing Address
First Line	:	16620 N 40TH ST
Second Line	:	STE I-5
City	:	PHOENIX
State	:	AZ
Zip	:	85032-3348
Country	:	US
Telephone Number	:	602-482-1300
Fax Number	:	480-718-7342

Provider Business Practice Location Address
First Line	:	16620 N 40TH ST
Second Line	:	STE I-5
City	:	PHOENIX
State	:	AZ
Zip	:	85032-3348
Country	:	US
Telephone Number	:	602-482-1300
Fax Number	:	480-718-7342

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	04/26/2011

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