Individual
DEREK BRENT JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
5121 S COTTONWOOD STREET, INTERMOUNTAIN MEDICAL CENTER, MURRAY, UT 84157-2520
(801) 507-5248
Mailing address
3136 LOWER SADDLEBACK RD, PARK CITY, UT 84098-4829
(801) 707-7423
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
359058-1204
UT
390200000X
Student in an Organized Health Care Education/Training Program
2006018684
MO
Other
Enumeration date
06/07/2007
Last updated
01/09/2012
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