Individual
CHARLES E JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1501 E CALVADA BLVD, PAHRUMP, NV 89048-5807
(775) 727-5509
(775) 727-5696
Mailing address
PO BOX 98978, LAS VEGAS, NV 89193-8978
(702) 507-2419
(702) 671-6883
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-C0149
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124090949
—
NV
01
—
P00865044
RAILROAD MEDICARE
NV
Enumeration date
02/06/2006
Last updated
01/25/2012
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