MEDICARE: ERIC 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	207RH0003X	Hematology & Oncology Physician	1649665399	UT
2	390200000X	Student in an Organized Health Care Education/Training Program

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	:	1649665399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC JOHNSON M.D.

Provider Business Mailing Address
First Line	:	4401 HARRISON BLVD
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-3195
Country	:	US
Telephone Number	:	801-387-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 HARRISON BLVD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84132-0001
Country	:	US
Telephone Number	:	702-370-9273
Fax Number	:

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

Provider Enumeration Date	:	03/31/2015
Last Update Date	:	07/02/2021

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