Individual
STEPHEN C JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
895 N 6TH E, MOUNTAIN HOME, ID 83647-2207
(702) 453-3799
(702) 453-5741
Mailing address
PO BOX 507, MOUNTAIN HOME, ID 83647-0507
(702) 453-3799
(702) 453-5741
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0-41
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000769100
—
ID
Enumeration date
08/26/2005
Last updated
07/11/2016
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