Mark Dale Johnson (NPI# 1184668659, PAC ID# 6406872803) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1184668659 |
| PAC ID by PECOS | 6406872803 |
| Professional Enrollment ID | I20051014000515 |
| Full Name | Mark Dale Johnson |
| Organization Legal Name | JORDAN RIDGE FAMILY MEDICINE PLLC |
| Address |
6321 S Redwood Rd Suite 201 Salt Lake City UT 84123-6972 |
| Phone Number | 8012652212 |
| Gender | M |
| Credential | MD |
| Medical School | UNIVERSITY OF UTAH SCHOOL OF MEDICINE |
| Graduation Year | 1989 |
| Primary Specialty | FAMILY MEDICINE |
| Group Practice PAC ID | 8820091473 |
| Number of Group Practice Members | 4 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 460010 | INTERMOUNTAIN MEDICAL CENTER |
| 460049 | THE ORTHOPEDIC SPECIALTY HOSPITAL |
| 460051 | JORDAN VALLEY MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 6321 S Redwood Rd, Suite 201, Salt Lake City, UT 84123-6972 | 8012652212 | JORDAN RIDGE FAMILY MEDICINE PLLC |
| Organization Legal Name | JORDAN RIDGE FAMILY MEDICINE PLLC |
| Physicians | 4 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Gay Lynn Meyers | Physician Assistant | Jordan Ridge Family Medicine Pllc | 6321 S Redwood Rd, Suite 201, Salt Lake City, UT 84123-6972 |
| David Scott Anderson | Physician Assistant | Jordan Ridge Family Medicine Pllc | 6321 S Redwood Rd, Suite 201, Salt Lake City, UT 84123-6972 |
| Tanya Jean Chesley | Physician Assistant | Jordan Ridge Family Medicine Pllc | 6321 S Redwood Rd, Suite 201, Salt Lake City, UT 84123-6972 |
| Street Address |
6321 S REDWOOD RD SUITE 201 |
| City | SALT LAKE CITY |
| State | UT |
| Zip | 84123-6972 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Gay Lynn Meyers | Physician Assistant | Jordan Ridge Family Medicine Pllc | 6321 S Redwood Rd, Suite 201, Salt Lake City, UT 84123-6972 |
| Bhavananda T Reddy | Cardiovascular Disease (cardiology) | Genesis Vascular of Salt Lake | 6321 S Redwood Rd, Suite 102, Taylorsville, UT 84123-6799 |
| David Scott Anderson | Physician Assistant | Jordan Ridge Family Medicine Pllc | 6321 S Redwood Rd, Suite 201, Salt Lake City, UT 84123-6972 |
| Tanya Jean Chesley | Physician Assistant | Jordan Ridge Family Medicine Pllc | 6321 S Redwood Rd, Suite 201, Salt Lake City, UT 84123-6972 |
| Jacob D Erekson | Physical Therapy | Redwood Injury Treatment Center Inc | 6321 S Redwood Rd, Taylorsville, UT 84123-6799 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jon Randal Young | Podiatry | 4370 S Redwood Rd, Suite B, Taylorsville, UT 84123-2223 | |
| Homer Ronald Brown | Podiatry | 4370 S Redwood Rd, Suite B, Salt Lake City, UT 84123-2223 | |
| Joanie Marie Limb | Nurse Practitioner | Amazing Medical Associates Inc | 434 W Ascension Way, Suite 225, Murray, UT 84123-2790 |
| Sheri Lynn Schlagel | Nurse Practitioner | Amazing Medical Associates Inc | 434 W Ascension Way, Suite 225, Murray, UT 84123-2790 |
| Jennifer N Griswold | Nurse Practitioner | Amazing Medical Associates Inc | 434 W Ascension Way, Suite 225, Murray, UT 84123-2790 |
| Gabriella Dame | Nurse Practitioner | Amazing Medical Associates Inc | 434 W Ascension Way, Suite 225, Murray, UT 84123-2790 |
| Kearsta Washburn | Nurse Practitioner | Amazing Medical Associates Inc | 434 W Ascension Way, Suite 225, Murray, UT 84123-2790 |
| Alisha A Richins | Nurse Practitioner | Amazing Medical Associates Inc | 434 W Ascension Way, Suite 225, Murray, UT 84123-2790 |
| Aubrey Ann Kruisman | Nurse Practitioner | Amazing Medical Associates Inc | 434 W Ascension Way, Suite 225, Murray, UT 84123-2790 |
| Stephen L Miller | Cardiovascular Disease (cardiology) | Intermountain Heart Center PC | 5292 S College Dr, Suite 201, Murray, UT 84123-2958 |
| Find all physicians in zip 84123 | |||
| City | SALT LAKE CITY |
| Zip Code | 84123 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | SALT LAKE CITY + FAMILY MEDICINE |
Please comment or provide details below to improve the information on Mark Dale 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.