Provider Demographics
NPI:1699085548
Name:JOSEPH W. JOHNSON, M.D., LTD
Entity type:Organization
Organization Name:JOSEPH W. JOHNSON, M.D., LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:W
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-565-8911
Mailing Address - Street 1:106 E LAKE MEAD PARKWAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-5534
Mailing Address - Country:US
Mailing Address - Phone:702-565-8911
Mailing Address - Fax:702-565-9884
Practice Address - Street 1:106 E. LAKE MEAD PARKWAY
Practice Address - Street 2:SUITE 104
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-5534
Practice Address - Country:US
Practice Address - Phone:702-565-8911
Practice Address - Fax:702-565-9884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3304207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506440Medicaid
NVC96188Medicare UPIN
NVVMD3304Medicare PIN