Individual
JASON ALAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2493 S WILDCAT WAY UNIT B, WOODS CROSS, UT 84010-8292
(801) 693-3020
(801) 693-3024
Mailing address
625 CAYIAS DR, NORTH SALT LAKE, UT 84054-3161
(775) 505-7111
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11431575-1205
UT
207Q00000X
Family Medicine Physician
15746
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11431575-1205
UT LICENSE
UT
01
—
12790436
CAQH
NV
01
—
15746
MD LICENSE NUMBER
NV
Enumeration date
04/26/2012
Last updated
02/17/2025
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