Individual
JEFFREY W JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1055 N 500 W STE 212, PROVO, UT 84604-3305
(801) 374-2362
(801) 429-8196
Mailing address
1055 N 500 W, ATTN: CREDENTIALING, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
1716591205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04-00467
UNITED HEALTHCARE
UT
01
—
107006671101
IHC HEALTHPLANS
UT
01
—
110037853
PALMETTO GBA
UT
01
—
16205
PEHP
UT
01
—
2556
DMBA
UT
01
—
QM0000000053
ALTIUS
UT
Enumeration date
05/04/2006
Last updated
11/27/2023
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