Organization
BROADWAY CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTOINE DOUGLASS JOHNSON MD (FAMILY MEDICINE PHYICIAN CEO BROAWA)
(360) 538-7292
Entity
Organization
Contact information
Practice address
104 W 4TH ST, SUITE # 105, ABERDEEN, WA 98520-3932
(360) 538-7292
(360) 533-2566
Mailing address
PO BOX 149, ABERDEEN, WA 98520-0063
(360) 538-7292
(360) 533-2566
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7109903
—
WA
Enumeration date
08/30/2006
Last updated
08/22/2020
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