Individual provider · NPI-1
Brandon Bruce Johnson
Radiologic Technologist, Magnetic Resonance Imaging · Salt Lake City, UT
NPI number1962089532
StatusActive
Last updated in NPPESMar 28, 2021
Details
- NPI
- 1962089532
- Entity type
- Individual (NPI-1)
- Name
- Brandon Bruce Johnson
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 28, 2021
- Certification date
- Mar 28, 2021
- Last updated
- Mar 28, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2471M1202X | Radiologic Technologist, Magnetic Resonance Imaging | 5387619-5401 | UT | Yes |
| 2471C3401X | Radiologic Technologist, Computed Tomography | 5387619-5401 | UT | |
| 247100000X | Radiologic Technologist | 5387619-5401 | UT |
Practice location
500 Foothill BlvdSalt Lake City, UT 84148-0001
Phone 801-582-1565
Mailing address
3085 Oakwood DrBountiful, UT 84010-4439
Phone 801-946-7400
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