Provider Demographics
NPI:1285012666
Name:JOHNSON, JOSHUA JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:JAMES
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VDS CREDENTIALING
Other - Middle Name:MARIA VALVERDE
Other - Last Name:DEPT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CREDENTIALING TEAM
Mailing Address - Street 1:3877 N 7TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5061
Mailing Address - Country:US
Mailing Address - Phone:602-258-6797
Mailing Address - Fax:602-248-8113
Practice Address - Street 1:334 W 10TH PL # S100
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3497
Practice Address - Country:US
Practice Address - Phone:602-258-6797
Practice Address - Fax:602-248-8119
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2025-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ54354207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ454026Medicaid