Individual
MARK A JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1648 NW 1ST STREET, MERIDIAN, ID 83642
(208) 888-9393
(208) 888-9525
Mailing address
1648 NW 1ST STREET, MERIDIAN, ID 83642
(208) 888-9393
(208) 888-9525
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
O-0583
ID
207Q00000X
Family Medicine Physician
OL20000133
WA
Other
Enumeration date
07/11/2008
Last updated
02/20/2017
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