Gary Blake Johnson (NPI# 1144223827, PAC ID# 4789625690) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is UROLOGY.
| Nation Provider ID (NPI) | 1144223827 |
| PAC ID by PECOS | 4789625690 |
| Professional Enrollment ID | I20050519001121 |
| Full Name | Gary Blake Johnson |
| Organization Legal Name | GRANGER MEDICAL CLINIC INC |
| Address |
1060 E 100 Suite 110 Salt Lake City UT 84102-1591 |
| Phone Number | 8015319453 |
| Gender | M |
| Credential | MD |
| Medical School | NEW YORK MEDICAL COLLEGE |
| Graduation Year | 1999 |
| Primary Specialty | UROLOGY |
| Group Practice PAC ID | 3476465691 |
| Number of Group Practice Members | 159 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 531313 | STAR VALLEY MEDICAL CENTER |
| 460003 | SALT LAKE REGIONAL MEDICAL CENTER |
| 460010 | INTERMOUNTAIN MEDICAL CENTER |
| 530015 | ST JOHNS MEDICAL CENTER |
| 460006 | LDS HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 196 Arrowhead Dr, Suite 5, Evanston, WY 82930-8752 | 3077838365 | EVANSTON CLINIC CORP |
| 555 E Broadway Ave, Suite 207, Jackson, WY 83001-8640 | 3077337460 | UROLOGY ASSOCIATES MEDICAL GROUP, PC |
| 1060 E 100, Suite 110, Salt Lake City, UT 84102-1591 | 8015319453 | GRANGER MEDICAL CLINIC INC |
| 6360 S 3000, Suite 100, Salt Lake City, UT 84121-6924 | 8014863021 | GRANGER MEDICAL CLINIC INC |
| Organization Legal Name | GRANGER MEDICAL CLINIC INC |
| Physicians | 158 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Javier Eduardo Chavez | Obstetrics/gynecology | Granger Medical Clinic Inc | 3181 S 9000, West Jordan, UT 84088 |
| Ginette I Speed | Nurse Practitioner | Granger Medical Clinic Inc | 181 E 5600, Suite 130, Murray, UT 84107-6127 |
| Casey J Henich | Family Medicine | Granger Medical Clinic Inc | 3725 W 4100, West Valley City, UT 84120-5530 |
| Jared H Mathis | Physician Assistant | Granger Medical Clinic Inc | 2326 N 400 E, C203, Tooele, UT 84074-3408 |
| David George Dienhart | Internal Medicine | Granger Medical Clinic Inc | 71 E 1280, Tooele, UT 84074-8120 |
| Melisa S Steele | Nurse Practitioner | Granger Medical Clinic Inc | 1121 E 3900, Suite C130 Millcreek, Salt Lake City, UT 84124-1200 |
| Robert D Williams | Family Medicine | Granger Medical Clinic Inc | 1288 W 12700, Riverton, UT 84065-6794 |
| Ian R Cavin | General Surgery | Granger Medical Clinic Inc | 4252 S Highland Dr, Suite 200, Salt Lake City, UT 84124-2690 |
| Stephen B Devenport | Family Medicine | Granger Medical Clinic Inc | 12391 S 4000, Riverton, UT 84096-7012 |
| Edwin R England | Obstetrics/gynecology | Granger Medical Clinic Inc | 11724 S State St, Draper, UT 84020-7163 |
| Street Address |
1060 E 100 SUITE 110 |
| City | SALT LAKE CITY |
| State | UT |
| Zip | 84102-1591 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Fawad A Tanvir | Infectious Disease | Alpine Medical Group | 1060 E 100, Suite L10, Salt Lake City, UT 84102-1553 |
| Mara L Rabin | Family Medicine | Alpine Medical Group | 1060 E 100, Suite L10, Salt Lake City, UT 84102-1553 |
| Yong Hui H Ahn | Internal Medicine | Alpine Medical Group | 1060 E 100, Suite L10, Salt Lake City, UT 84102-1553 |
| Ryan W Wilkes | Psychologist, Clinical | 1060 E 100, Suite 100, Salt Lake City, UT 84102-1582 | |
| Valerie K Lambert | Clinical Social Worker | 1060 E 100, Suite 202, Salt Lake City, UT 84102-4306 | |
| Michael Darwin Killpack | Internal Medicine | Alpine Medical Group | 1060 E 100, Suite L10, Salt Lake City, UT 84102-1553 |
| Amy L Fehlberg | Psychologist, Clinical | 1060 E 100, Suite 100, Salt Lake City, UT 84102-1582 | |
| Bradley James Waterman | Urology | Granger Medical Clinic Inc | 1060 E 100, Suite 110, Salt Lake City, UT 84102-1591 |
| Nicholas G Hanson | Family Medicine | Alpine Medical Group | 1060 E 100, Suite L10, Salt Lake City, UT 84102-1553 |
| Beth Chapman Hanlon | Internal Medicine | Alpine Medical Group | 1060 E 100, Suite L10, Salt Lake City, UT 84102-1553 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Amy N De La Garza | Family Medicine | 77 S 700, Suite 220, Salt Lake City, UT 84102-1162 | |
| Charles Ty Nuttall | Clinical Social Worker | 699 E S Temple, Suite 300, Salt Lake City, UT 84102-1186 | |
| Darren F Groberg | Podiatry | Utah Podiatric Physicians and Surgeons Group LLC | 144 S 700, Salt Lake City, UT 84102-1357 |
| Daniel Preece | Podiatry | Utah Podiatric Physicians and Surgeons Group LLC | 144 S 700, Salt Lake City, UT 84102-1357 |
| Steven R Taylor | Otolaryngology | Intermountain Ear Nose and Throat Specialists LLC | 22 S 900, Salt Lake City, UT 84102-1394 |
| Kian Eftekhari | Ophthalmology | Intermountain Ear Nose and Throat Specialists LLC | 22 S 900, Salt Lake City, UT 84102-1394 |
| Balimar B Lindgren | Nurse Practitioner | Santibanez Aguirre PC | 165 S 1000, Salt Lake City, UT 84102-1402 |
| Edwin Awinda | Nurse Practitioner | Santibanez Aguirre PC | 165 S 1000, Salt Lake City, UT 84102-1402 |
| Bernard M Mutie | Nurse Practitioner | Santibanez Aguirre PC | 165 S 1000, Salt Lake City, UT 84102-1402 |
| Nathan Michael Hastings | Hospitalist | Santibanez Aguirre PC | 165 S 1000, Salt Lake City, UT 84102-1402 |
| Find all physicians in zip 84102 | |||
| City | SALT LAKE CITY |
| Zip Code | 84102 |
| Specialty | UROLOGY |
| City + Specialty | SALT LAKE CITY + UROLOGY |
Please comment or provide details below to improve the information on Gary Blake Johnson.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.