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Individual

JUSTIN MICHAEL JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
1075 N CURTIS RD STE 300, BOISE, ID 83706-1348
(208) 302-3100
(208) 302-3155
Mailing address
3340 E GOLDSTONE DR, MERIDIAN, ID 83642-1026
(208) 367-5170
(208) 367-5180

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10816599-1206
UT
363A00000X
Physician Assistant
Primary
PA-2296
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1619362480
NV
Enumeration date
03/30/2015
Last updated
08/26/2022
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