Individual
G THEODORE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1100 9TH AVE, SEATTLE, WA 98101-2756
(206) 223-6600
(206) 515-5886
Mailing address
1100 OLIVE WAY, MS: M4-PA, SEATTLE, WA 98101-1873
(206) 515-5811
(206) 515-5886
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD00015190
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039578
L&I
WA
05
—
8128902
—
WA
01
—
930018996
RAIL ROAD MEDICARE
WA
01
—
J449
INDIVIDUAL BLUE SHIELD
WA
Enumeration date
05/10/2006
Last updated
05/15/2008
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