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Contact Information

BLAKE W JOHNSON, DO
3580 W 9000 S
WEST JORDAN, UT84088-8812
 Phone: 801-561-8888
 Fax: 480-507-2971
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Anesthesiology

207L00000X 79 Physician/Addiction Medicine
Indicates primary specialty

NPI Profile & details for BLAKE W JOHNSON · (Male)

NPI # 1760502991
Status Active
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 03/30/2007
Last updated 06/19/2015 - About 11 years ago
Sole proprietor 1 Yes
Identifiers
  • KS License # 94-06211 TEMPORARY
  • UT License # 6919190-1240
  • UT Medicaid 1841453362
Hospital affiliation(s)
  • JORDAN VALLEY MEDICAL CENTER - (Acute Care)
    3580 WEST 9000 SOUTH
    WEST JORDAN, UT 84088
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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