Individual
MR. MICHAEL DEAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
401 BURRO ALLEY, MORENCI, AZ 85540
(928) 865-9184
(928) 865-7571
Mailing address
PO BOX 218, 401 BURRO ALLEY, MORENCI, AZ 85540
(928) 865-9184
(928) 865-7571
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2002-0054
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080193055
RR MEDICARE
—
05
—
32205023
—
NM
Enumeration date
07/06/2005
Last updated
10/23/2012
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