Individual
GARY BLAKE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
24 S 1100 E STE 105, SALT LAKE CITY, UT 84102-1593
(801) 965-3600
Mailing address
2965 W 3500 S, WEST VALLEY CITY, UT 84119-3602
(801) 965-3600
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
5860718-1205
UT
208800000X
Urology Physician
Primary
5860718-1205
UT
Other
Enumeration date
05/24/2005
Last updated
02/04/2025
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