Individual
MICHAEL EUGENE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1520 N DIVISION ST, BLYTHEVILLE, AR 72315-1448
(870) 838-7460
Mailing address
PO BOX 24086, FORT WORTH, TX 76124-1086
(817) 451-4208
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
E2802
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130216001
—
AR
01
—
5L772
BLUE CROSS BLUE SHIELD
AR
01
—
P00285103
RR MEDICARE
AR
Enumeration date
05/26/2006
Last updated
07/02/2008
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