MEDICARE: TREVOR E JOHNSON AA

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	367H00000X	Anesthesiologist Assistant	67.000162	OH

General Provider Information

NPI Number	:	1760710735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREVOR E JOHNSON AA

Provider Business Mailing Address
First Line	:	7757 AUBURN RD STE 15
Second Line	:
City	:	PAINESVILLE
State	:	OH
Zip	:	44077-9604
Country	:	US
Telephone Number	:	440-350-0832
Fax Number	:	440-354-7420

Provider Business Practice Location Address
First Line	:	72 VILLAGE WAY STE 2B
Second Line	:
City	:	HUDSON
State	:	OH
Zip	:	44236-5127
Country	:	US
Telephone Number	:	330-656-5215
Fax Number	:

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

Provider Enumeration Date	:	12/02/2009
Last Update Date	:	02/27/2020

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Directions to “ TREVOR E JOHNSON AA” Practice Location

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