Provider Demographics
NPI:1902898620
Name:JOHNSON, STEVEN W (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:W
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 1:25500 N. NORTERRA PARKWAY
Mailing Address - Street 2:BLDG. B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085
Mailing Address - Country:US
Mailing Address - Phone:602-588-3800
Mailing Address - Fax:602-588-3764
Practice Address - Street 1:5891 W. EUGIE AVENUE
Practice Address - Street 2:
Practice Address - City:COLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304
Practice Address - Country:US
Practice Address - Phone:602-588-6600
Practice Address - Fax:602-588-6906
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015924207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8151508Medicaid
WA8851897Medicare ID - Type Unspecified
WA8151508Medicaid