Provider Demographics
NPI:1427053867
Name:JOHNSON, JARROD D (DO)
Entity type:Individual
Prefix:DR
First Name:JARROD
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:LITTLEFIELD
Mailing Address - State:AZ
Mailing Address - Zip Code:86432-0490
Mailing Address - Country:US
Mailing Address - Phone:928-347-5971
Mailing Address - Fax:928-347-5793
Practice Address - Street 1:I15 EXIT 9 @ THE FIRESTATION
Practice Address - Street 2:
Practice Address - City:LITTLEFIELD
Practice Address - State:AZ
Practice Address - Zip Code:86432-0490
Practice Address - Country:US
Practice Address - Phone:928-347-5971
Practice Address - Fax:928-347-5793
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4092207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ856940Medicaid
AZ856940Medicaid
AZ82026Medicare ID - Type Unspecified