Individual
DR. MAYBEN COLE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
526 SHOUP AVE W, TWIN FALLS, ID 83301
(208) 733-1112
(208) 732-1212
Mailing address
526 SHOUP AVE W, TWIN FALLS, ID 83301
(208) 733-1112
(208) 732-1212
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
O278
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010137639
REGENCE BLUE SHIELD OF ID
ID
01
—
S3788
BLUE CROSS OF ID
ID
Enumeration date
10/25/2006
Last updated
07/08/2007
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