1851314991 NPI number — JEREMY DANIEL JOHNSON M.D.

Table of content: JEREMY DANIEL JOHNSON M.D. (NPI 1851314991)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851314991 NPI number — JEREMY DANIEL JOHNSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
JEREMY
Provider Middle Name:
DANIEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851314991
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 JARRETT WHITE ROAD
Provider Second Line Business Mailing Address:
TRIPLER ARMY MEDICAL CENTER- DEPARTMENT FAMILY MEDICINE
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96859-5000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-433-1690
Provider Business Mailing Address Fax Number:
808-433-1153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNIT 45011
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96343-5011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-263-4127
Provider Business Practice Location Address Fax Number:
315-263-3866
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  10056269A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com