Individual
JEDIDIAH JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6424 E BROADWAY RD STE 101, MESA, AZ 85206-1750
(480) 456-9000
Mailing address
1201 S ALMA SCHOOL RD STE 14000, MESA, AZ 85210-2096
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
7194
AZ
363A00000X
Physician Assistant
—
—
Other
Enumeration date
08/27/2018
Last updated
01/30/2019
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