Individual
RICHARD KENT JOHANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1100 N SAN FRANCISCO ST, STE B, FLAGSTAFF, AZ 86001-3260
(928) 779-7851
(928) 774-0508
Mailing address
1100 N SAN FRANCISCO ST, STE B, FLAGSTAFF, AZ 86001-3260
(928) 779-7851
(928) 774-0508
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
20135
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
053405
—
AZ
Enumeration date
08/31/2005
Last updated
08/06/2012
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