NPIMap

Organization Active NPI

Mydockj

  • Family Medicine Physician
  • Scottsdale, AZ
National Provider Identifier
1407129646
Registry record updated Feb 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
19257 Issued in AZ
Legal business name
MYDOCKJ
Practice address
8520 E Shea Blvd
Ste 105
Scottsdale, AZ 85260-6677
Phone
(602) 390-1509
NPI assigned
Feb 20, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kim D Johnson, MDNPI 1902987936
Title
President
Phone
(602) 390-1509

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 19257 AZ Primary

Addresses

Primary practice location

8520 E Shea Blvd
Ste 105
Scottsdale, AZ 85260-6677

Mailing address

10105 E Via Linda
Ste 103-364
Scottsdale, AZ 85258-5311
Phone (602) 390-1509

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1329696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329696000000",
    "number": "1407129646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10105 E VIA LINDA",
            "address_2": "STE 103-364",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852585311",
            "telephone_number": "602-390-1509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8520 E SHEA BLVD",
            "address_2": "STE 105",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852606677",
            "telephone_number": "602-390-1509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYDOCKJ",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-20",
        "last_updated": "2012-02-20",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "602-390-1509",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "19257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Scottsdale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.