Individual
TIMOTHY DAVID JOHANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1501 N. CAMPBELL AVE., TUCSON, AZ 85724
(952) 920-9191
(952) 920-0232
Mailing address
2701 E. ELVIRA RD, TUCSON, AZ 85756-7124
(520) 626-0923
(520) 626-2808
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
33782
MN
208000000X
Pediatrics Physician
Primary
51152
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1200632
MEDICA
—
01
—
47B40JO
BLUE CROSS BLUE SHIELD
MN
05
—
496002500
—
MN
01
—
CP9020830013
PREFERRED ONE
—
Enumeration date
07/28/2006
Last updated
02/08/2016
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