Individual
DR. BRENT MITCHELL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2331 FRANKLIN RD SW, ROANOKE, VA 24014-1111
(540) 725-1226
(540) 857-5306
Mailing address
2331 FRANKLIN RD SW, ROANOKE, VA 24014-1111
(540) 725-1226
(540) 857-5306
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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