MEDICARE: RICHARD 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	207R00000X	Internal Medicine Physician	41832	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700837622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD W JOHNSON M.D.

Provider Business Mailing Address
First Line	:	1200 N. EL DORADO PLACE
Second Line	:	F-670
City	:	TUCSON
State	:	AZ
Zip	:	85715-4637
Country	:	US
Telephone Number	:	520-324-4774
Fax Number	:	520-324-2567

Provider Business Practice Location Address
First Line	:	5300 E ERICKSON DR
Second Line	:	STE 116
City	:	TUCSON
State	:	AZ
Zip	:	85712-2828
Country	:	US
Telephone Number	:	520-324-3940
Fax Number	:	520-324-3935

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	08/30/2012

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