Basic Information
| Provider Information | |||||||||
| NPI: | 1528222593 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 31235 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857511235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203244780 | ||||||||
| FaxNumber: | 5203241406 | ||||||||
| Practice Location | |||||||||
| Address1: | 2424 N WYATT DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857126115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203248621 | ||||||||
| FaxNumber: | 5203243935 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2008 | ||||||||
| LastUpdateDate: | 06/26/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | R70572 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 45028 | AZ | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 45028 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 673142 | 05 | AZ | MEDICAID |