Individual
KOLBY V JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
465 MEMORIAL DR, POCATELLO, ID 83201-4008
(208) 282-4421
(208) 282-4818
Mailing address
465 MEMORIAL DR, POCATELLO, ID 83201-4008
(208) 282-4421
(208) 282-4818
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MR-1195
ID
Other
Enumeration date
06/30/2011
Last updated
06/30/2011
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