Individual
JEREMIAH DAVID JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4901 LANG AVE NE, ALBUQUERQUE, NM 87109-4397
(505) 842-8171
(505) 246-0684
Mailing address
4901 LANG AVE NE, ALBUQUERQUE, NM 87109-4397
(505) 842-8171
(505) 246-0684
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
53837
KY
2085R0001X
Radiation Oncology Physician
Primary
MD2023-1654
NM
Other
Enumeration date
04/04/2018
Last updated
06/11/2024
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