Provider Demographics
NPI:1174597058
Name:JOHNSON, DAVID HOWARD (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:HOWARD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2874 N. CARSON STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-1682
Mailing Address - Country:US
Mailing Address - Phone:775-283-3096
Mailing Address - Fax:775-283-3096
Practice Address - Street 1:925 IRONWOOD DRIVE
Practice Address - Street 2:SUITE 2103
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-5180
Practice Address - Country:US
Practice Address - Phone:775-445-7885
Practice Address - Fax:775-783-9550
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4143208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003103057Medicaid
NV002003057Medicaid
NV003103057Medicaid
NVV105673Medicare PIN