Individual
CODY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
190 E BANNOCK ST FL 10, BOISE, ID 83712-6241
(208) 381-5500
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2399
ID
363A00000X
Physician Assistant
—
—
Other
Enumeration date
09/03/2021
Last updated
11/30/2022
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