Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 006929 | AZ |
Y | 208600000X | Surgeon | 006929 | AZ |
N | 2082S0105X | Plastic Hand Surgeon | 006929 | AZ |
NPI | 1780709394 |
---|---|
Provider Name | Dr. Jason D Johnson |
First Address | Peoria, AZ 85381-5626 |
Second Address | Peoria, AZ 85381-5626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 11/03/2021 |