Individual
MR. ANTHONY LANCE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4103 MERCANTILE DR, LAKE OSWEGO, OR 97035-2556
(503) 850-9940
(503) 850-6709
Mailing address
4103 MERCANTILE DR, LAKE OSWEGO, OR 97035-2556
(503) 850-9940
(503) 850-6709
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA208077
OR
363A00000X
Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/24/2020
Last updated
02/08/2022
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