Individual
JEFF L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 W 8TH AVE, SPOKANE, WA 99204-2307
(509) 474-3260
Mailing address
PO BOX 421, LIBERTY LAKE, WA 99019-0421
(866) 747-2455
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00034928
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558353201
—
WA
01
—
P01308988
RR MEDICARE
WA
Enumeration date
08/18/2005
Last updated
12/18/2015
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