Individual
MR. FREDERICK FARMAN JOHNSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.M.T.
Contact information
Practice address
334 NE IRVING AVENUE, PORTLAND, OR 97702
(541) 419-4019
Mailing address
334 NE IRVING AVE., 102, BEND, OR 97702
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
18101
OR
172V00000X
Community Health Worker
Primary
18101
OR
Other
Enumeration date
02/06/2012
Last updated
02/06/2012
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