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Organization

SARA L. JOHNSON, MD

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. SARA JOHNSON M.D. (OWNER)
(208) 733-2885
Entity
Organization

Contact information

Practice address
496 SHOUP AVE W, SUITE E, TWIN FALLS, ID 83301-5043
(208) 733-2885
(208) 734-3352
Mailing address
496 SHOUP AVE W, SUITE E, TWIN FALLS, ID 83301-5043
(208) 733-2885
(208) 734-3352

Taxonomy

Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
M4188
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010017978
REGENCE BLUE SHIELD OF ID
ID
01
8H757
BLUE CROSS OF IDAHO
ID
Enumeration date
12/28/2006
Last updated
06/17/2008
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