Individual
LANE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2800 E AJO WAY, TUCSON, AZ 85713-6204
(520) 874-3500
Mailing address
2701 E ELVIRA RD, TUCSON, AZ 85706-7124
(520) 874-3500
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15577
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00350079
RR MEDICARE
AZ
Enumeration date
02/17/2006
Last updated
05/30/2008
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