Organization
MINI-CASSIA SURGICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DACLYNN SCOTT JOHNSON M.D. (PRESIDENT)
(208) 436-8340
Entity
Organization
Contact information
Practice address
1218 9TH ST, STE 10, RUPERT, ID 83350-2207
(208) 436-8340
(208) 436-3956
Mailing address
1218 9TH ST, STE 10, RUPERT, ID 83350-2207
(208) 436-8340
(208) 436-3956
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
M7497
ID
Other
Enumeration date
01/25/2011
Last updated
01/25/2011
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