Provider Demographics
NPI:1285966945
Name:JOHNSON, DANIEL ADAM (IDMT)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ADAM
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8697 S DESERT RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-5032
Mailing Address - Country:US
Mailing Address - Phone:520-861-0580
Mailing Address - Fax:
Practice Address - Street 1:8697 S DESERT RAINBOW DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-5032
Practice Address - Country:US
Practice Address - Phone:520-861-0580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians