Individual
DAVID ELLSWORTH JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3100 TONGASS AVE, KETCHIKAN, AK 99901-5746
(907) 225-4463
Mailing address
PO BOX 6852, KETCHIKAN, AK 99901-1852
(907) 225-6396
(907) 247-5951
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
1160
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MD1213
—
AK
01
—
R004
TRICARE
AK
Enumeration date
12/05/2006
Last updated
07/08/2007
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