Individual
WAYNE DENNIS JOHNSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDMT
Contact information
Practice address
2504 S CHICAGO ST, FAIRCHILD AFB, WA 99011-8548
(509) 247-5414
Mailing address
2504 S CHICAGO ST, FAIRCHILD AFB, WA 99011-8548
(509) 247-5414
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
07/14/2009
Last updated
07/14/2009
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