| Doctor Name: | DR. JESSE CLARK JOHNSON |
| NPI Number: | 1033146212 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 4301078527 |
| Business Practice Address: | 1105 6th St Traverse City, MI - 496842345 |
| Business Phone Number: | 2319350499 |
| Business Fax Number: | |
| Mailing Address: | 1105 6th St, TRAVERSE CITY |
| State: | MI |
| Postal Code: | 496842345 |
| Phone Number: | 2319350499 |
| Fax Number: | |
| NPI Enumeration Date: | 06/26/2006 |
| NPI Last Update Date: | 10/26/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085R0202X |
| License Number: | 4301078527 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Diagnostic Radiology |
| Taxonomy Definition: | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |