Individual
MR. DALLEN M JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAA. MSA
Contact information
Practice address
3001 BROADMOOR BLVD NE, RIO RANCHO, NM 87144-2100
(385) 278-9148
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
75000078A
IN
367H00000X
Anesthesiologist Assistant
AA2024-0001
NM
Other
Enumeration date
11/06/2012
Last updated
12/01/2025
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