| Glen E Johnson Md Pc | |
|
3940 W 4100 S West Valley City UT 84120-5450 | |
| (801) 966-3700 | |
| (801) 966-9421 |
| Full Name | Glen E Johnson Md Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3940 W 4100 S, West Valley City, Utah |
| Authorized Official Name and Position | Glen E Johnson (OWNER) |
| Authorized Official Contact | 8019663700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Glen E Johnson Md Pc 555 E 4500 S Ste C150 Salt Lake City UT 84107-4507 Ph: (801) 288-0747 | Glen E Johnson Md Pc 3940 W 4100 S West Valley City UT 84120-5450 Ph: (801) 966-3700 |
| NPI Number | 1336443373 |
|---|---|
| Provider Enumeration Date | 01/05/2011 |
| Last Update Date | 01/05/2011 |
| Medicare PECOS PAC ID | 1052590437 |
|---|---|
| Medicare Enrollment ID | O20110201000553 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336443373 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 154764-1205 (Utah) | Primary |
| Provider Name | Glen E Johnson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1326157298 PECOS PAC ID: 7214116698 Enrollment ID: I20110201000720 |
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