Organization
DAVID JOHNSON, M.D., P. A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID A JOHNSON M.D. (PHYSICIAN)
(208) 814-7150
Entity
Organization
Contact information
Practice address
775 POLE LINE RD W, SUITE 213, TWIN FALLS, ID 83301-5814
(208) 814-8475
(208) 734-4177
Mailing address
775 POLE LINE RD W, SUITE 213, TWIN FALLS, ID 83301-5814
(208) 814-8475
(208) 734-4177
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
M9086
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003760400
—
ID
01
—
020051471
RR MEDICARE
ID
Enumeration date
05/31/2006
Last updated
03/09/2013
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