Individual
MARK L. JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1400 E. KINCAID ST., SKAGIT REGIONAL CLINICS, MOUNT VERNON, WA 98274-4127
(360) 428-2586
(360) 428-6470
Mailing address
1400 E. KINCAID ST., ATTN: CREDENTIALING, MOUNT VERNON, WA 98274-4127
(360) 428-2500
(360) 428-6485
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD00014524
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
263547
LABOR & INDUSTRIES
WA
Enumeration date
10/18/2005
Last updated
10/05/2012
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