Johnson, Derek B

Johnson, Derek B is an individual health care provider with primary practice located at 454 Saint Michaels Dr Ste 200 , Santa Fe NM 87505. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Johnson, Derek B can be contacted via phone (505) 303-5000.

Contact Information

Primary practice address
454 Saint Michaels Dr Ste 200 Santa Fe NM 87505
Phone: (505) 303-5000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 224930 Massachusetts
Allopathic & Osteopathic Physicians / Surgery 208600000X 49065 Wisconsin
Allopathic & Osteopathic Physicians / Surgery 208600000X MD2018-0748 New Mexico

Profile Details

NPI number 1912944661
LBN Legal business name Johnson, Derek B
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 1st, 2006
Last updated Aug 28th, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912944661 NPPES
Wisconsin MEDICAID 34863900
Wisconsin Other 057945003

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