| David Michael Johnson, | |
|
11578 N Broadleaf Hollow Ln, Highland, UT 84003-5633 | |
| (208) 577-8820 | |
| Not Available |
| Full Name | David Michael Johnson |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant - Medical |
| Location | 11578 N Broadleaf Hollow Ln, Highland, Utah |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891375416 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363AM0700X | Physician Assistant - Medical | 12423884-8906 (Utah) | Primary |
| Entity Name | Ihc Health Services Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1942325154 PECOS PAC ID: 1850209420 Enrollment ID: O20080610000303 |
| Entity Name | Utah Regional Hospitalists LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1962821223 PECOS PAC ID: 4789807165 Enrollment ID: O20140604000236 |
| Entity Name | Pai Participant 1 LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1093371312 PECOS PAC ID: 8123351954 Enrollment ID: O20200416000875 |
| Mailing Address | Practice Location Address |
|---|---|
| David Michael Johnson, 11578 N Broadleaf Hollow Ln, Highland, UT 84003-5633 Ph: (208) 577-8820 | David Michael Johnson, 11578 N Broadleaf Hollow Ln, Highland, UT 84003-5633 Ph: (208) 577-8820 |
Brooke Elizabeth Lopez, MMS, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 10290 N North County Blvd Ste 200, Highland, UT 84003 Phone: 801-899-3391 |