Individual
MARIAH JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3303 SW BOND AVE # 16D, PORTLAND, OR 97239
(503) 418-3376
Mailing address
3303 SW BOND AVE # 16D, PORTLAND, OR 97239-4501
(503) 418-3376
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
187670
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/21/2014
Last updated
08/27/2018
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