Most Relevant Information
Provider Data
| NPI Number: | 1003344789 |
| Provider Name: | BRETT M JOHNSON PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | 1081 |
Most Important Dates
| Enumeration Date: | 05/25/2017 |
| Last Updated: | 05/25/2017 |
Provider Practice Location
61 CHARLES ST
DEADWOOD
SD
577321303
Practice Location Phone/Fax
| Phone: | 6057176000 |
| Fax: |
Provider Mailing Location
61 CHARLES ST
DEADWOOD
SD
577321303
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |