Individual
JAY D. JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3801 LAKE OTIS PKWY STE 200, ANCHORAGE, AK 99508-5234
(907) 212-6900
Mailing address
3801 LAKE OTIS PKWY STE 200, ANCHORAGE, AK 99508-5234
(907) 212-6900
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
4028
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200001850A
—
OK
Enumeration date
12/19/2006
Last updated
08/04/2008
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