| Derek B Johnson, MD | |
|
454 Saint Michaels Dr Ste 200, Santa Fe, NM 87505 | |
| (505) 303-5000 | |
| Not Available |
| Full Name | Derek B Johnson |
|---|---|
| Gender | Male |
| Speciality | Surgery |
| Location | 454 Saint Michaels Dr Ste 200, Santa Fe, New Mexico |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912944661 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208600000X | Surgery | 224930 (Massachusetts) | Secondary |
| 208600000X | Surgery | 49065 (Wisconsin) | Secondary |
| 208600000X | Surgery | MD2018-0748 (New Mexico) | Primary |
| Entity Name | Presbyterian Healthcare Services |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1104802354 PECOS PAC ID: 9234041708 Enrollment ID: O20031103000603 |
| Entity Name | Roswell Clinic Corp |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1649267618 PECOS PAC ID: 9436062759 Enrollment ID: O20031111000799 |
| Mailing Address | Practice Location Address |
|---|---|
| Derek B Johnson, MD Po Box 26666, Phs Provider Enrollment, Albuquerque, NM 87125-6666 Ph: (505) 923-6770 | Derek B Johnson, MD 454 Saint Michaels Dr Ste 200, Santa Fe, NM 87505 Ph: (505) 303-5000 |
Poseidon Spyros Varvitsiotis, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 1631 Hospital Dr, Santa Fe, NM 87505 Phone: 505-988-3975 Fax: 505-986-8001 |
William Edgefield Mitchell Jr., MD Surgery Medicare: Medicare Enrolled Practice Location: 9a Rocky Slope Dr, Santa Fe, NM 87508 Phone: 505-473-3648 |
Anna M Voltura, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 4200 Beckner Rd, Santa Fe, NM 87507 Phone: 505-477-2200 |
John Dirk Wassner, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 465 Saint Michaels Dr, Suite 110, Santa Fe, NM 87505 Phone: 505-954-8720 |
Kimberly Ann Moseley, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 455 Saint Michaels Dr, Santa Fe, NM 87505 Phone: 505-913-3975 |
Dr. Anna-maria Alicia De Costa, MD, PHD Surgery Medicare: Accepting Medicare Assignments Practice Location: 4200 Beckner Rd, Santa Fe, NM 87507 Phone: 505-477-2200 |
Joseph M. Smith Iii, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 490b W Zia Rd, Suite A, Santa Fe, NM 87505 Phone: 505-995-8346 Fax: 505-995-8345 |