MEDICARE: STANLEY JOHNSEN M.D.

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	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	6324	AZ

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

General Provider Information

NPI Number	:	1568576320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STANLEY JOHNSEN M.D.

Provider Business Mailing Address
First Line	:	FILE 56765
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-6765
Country	:	US
Telephone Number	:	602-406-3860
Fax Number	:	602-406-6132

Provider Business Practice Location Address
First Line	:	222 W THOMAS RD
Second Line	:	SUITE 304
City	:	PHOENIX
State	:	AZ
Zip	:	85013-4419
Country	:	US
Telephone Number	:	602-406-3800
Fax Number	:	602-406-3810

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	04/24/2012

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