Provider Demographics
NPI:1174528004
Name:JOHNSON, JAMES M (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9305 W THOMAS RD
Mailing Address - Street 2:STE 155
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-3328
Mailing Address - Country:US
Mailing Address - Phone:623-936-1780
Mailing Address - Fax:623-936-9116
Practice Address - Street 1:9305 W THOMAS RD
Practice Address - Street 2:STE 155
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3328
Practice Address - Country:US
Practice Address - Phone:623-936-1780
Practice Address - Fax:623-936-9116
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2011-04-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ27769207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH60832Medicare UPIN