Individual
DR. BRENT MITCHELL JOHNSON
Active
Individual
DR. BRENT MITCHELL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
0101043592
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1679550933
AETNA
VA
05
—
1679550933
—
VA
01
—
371194700
BLACK LUNG
VA
01
—
3810018723
MEDICAID OF WEST VIRGINIA
VA
01
—
540506332005
TRICARE/CHAMPUS
VA
01
—
P00831109
RAILROAD MEDICARE
VA
Enumeration date
12/28/2005
Last updated
03/29/2016
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