Provider Demographics
NPI:1487874608
Name:JOHNSON, OSCAR C (PA -C)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:C
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PA -C
Other - Prefix:
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Mailing Address - Street 1:174 ROLLING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-3103
Mailing Address - Country:US
Mailing Address - Phone:801-913-1298
Mailing Address - Fax:801-299-1050
Practice Address - Street 1:3584 WEST 9000 SOUTH
Practice Address - Street 2:#405
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088
Practice Address - Country:US
Practice Address - Phone:801-601-2822
Practice Address - Fax:801-562-3169
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT101275-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant