Individual
JEFFERY L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3217 W BAVARIA STREET, EAGLE, ID 83616
(208) 239-1000
(208) 239-2136
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 286-6676
(208) 947-3419
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA416
ID
Other
Enumeration date
08/11/2006
Last updated
02/03/2021
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