Individual
GILBERT H JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1304 LAKE RD, ALTOONA, WI 54720-1849
(715) 832-0992
Mailing address
1304 LAKE RD, ALTOONA, WI 54720-1849
(715) 832-0992
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
218-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42946000
—
WI
Enumeration date
04/05/2006
Last updated
08/23/2011
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