# DAVID JOHNSON, M.D., P. A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467499418
- **Authorized official:** DAVID A JOHNSON M.D. (PHYSICIAN)
- **Authorized official phone:** (208) 814-7150

## Contact information

- **Practice address:** 775 POLE LINE RD W, SUITE 213, TWIN FALLS, ID 83301-5814
- **Practice address phone:** (208) 814-8475
- **Practice address fax:** (208) 734-4177
- **Mailing address:** 775 POLE LINE RD W, SUITE 213, TWIN FALLS, ID 83301-5814
- **Mailing address phone:** (208) 814-8475
- **Mailing address fax:** (208) 734-4177

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | M9086 | ID | Yes |

## Other

- **Enumeration date:** 05/31/2006
- **Last updated:** 03/09/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 003760400 | — | ID |
| 01 | — | 020051471 | RR MEDICARE | ID |