MEDICARE: DR. JOSEPH W. JOHNSON 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	207Q00000X	Family Medicine Physician	3304	NV

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	:	1578513057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH W. JOHNSON M.D.

Provider Business Mailing Address
First Line	:	2200 PASEO VERDE PKWY STE 260
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-2703
Country	:	US
Telephone Number	:	702-616-5801
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 N GIBSON RD STE 201
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89011-1706
Country	:	US
Telephone Number	:	702-616-5801
Fax Number	:

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	10/23/2017

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