Individual
JEDIDIAH E. JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
HS1, IDC
Contact information
Practice address
4688 HOMER SPIT RD, HOMER, AK 99603-8001
(360) 567-8238
Mailing address
4688 HOMER SPIT RD, USCGC HICKORY, HOMER, AK 99603
(360) 567-8238
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
CA
247200000X
Other Technician
—
—
Other
Enumeration date
10/23/2006
Last updated
10/08/2013
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