Individual
JAY A JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2103 INGERSOLL AVE, DES MOINES, IA 50312-5262
(515) 279-6424
(515) 279-3237
Mailing address
2103 INGERSOLL AVENUE, DES MOINES, IA 50312-5262
(515) 279-6424
(515) 279-3237
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3360
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0260901
—
IA
05
—
1497715262
—
IA
Enumeration date
03/25/2006
Last updated
08/09/2012
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