Provider Demographics
NPI:1336601913
Name:JOHNSON, DAVID VERE (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:VERE
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 1:2950 N CHURCH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-6590
Mailing Address - Country:US
Mailing Address - Phone:801-771-7771
Mailing Address - Fax:833-643-2775
Practice Address - Street 1:935 N 1000 W
Practice Address - Street 2:
Practice Address - City:TREMONTON
Practice Address - State:UT
Practice Address - Zip Code:84337-9356
Practice Address - Country:US
Practice Address - Phone:435-207-4800
Practice Address - Fax:435-207-4808
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11991423-1205207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine