Individual
GREG W JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
130 E BOISE AVE, BOISE, ID 83706
(208) 345-4066
(208) 345-4196
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 345-4066
(208) 345-4196
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M8930
ID
Other
Enumeration date
09/07/2006
Last updated
01/23/2014
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