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Individual

RUSSELL P JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
7021 SPRING MOUNTAIN RD, LAS VEGAS, NV 89117-3818
(702) 803-2222
(702) 829-7269
Mailing address
7021 SPRING MOUNTAIN RD, LAS VEGAS, NV 89117-3818
(702) 803-2222
(702) 829-7269

Taxonomy

Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
MA003569L
PA
363AM0700X
Medical Physician Assistant
MA003569L
PA
363AM0700X
Medical Physician Assistant
Primary
PA1753
NV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1336749811
GROUP NPI
NV
05
1497712483
NV
Enumeration date
04/26/2006
Last updated
11/27/2020
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