Individual
BRANDON JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
212 WASHINGTON ST, THE DALLES, OR 97058-2118
(503) 645-2749
Mailing address
PO BOX 16576, PORTLAND, OR 97292-0576
(503) 645-2749
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
10/18/2021
Last updated
10/18/2021
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