Individual
MR. EZEQUIEL ANTHONY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P-PRC
Contact information
Practice address
7091 W EMERALD ST, BOISE, ID 83704-8618
(208) 880-0863
Mailing address
7091 W EMERALD ST, BOISE, ID 83704-8618
(208) 880-0863
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
ID
Other
Enumeration date
08/03/2026
Last updated
08/03/2026
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