Individual
BLAKE G JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
738 N COLLEGE RD, SUITE A, TWIN FALLS, ID 83301-3385
(208) 814-7000
(208) 734-7294
Mailing address
PO BOX 587, TWIN FALLS, ID 83303-0587
(208) 814-7400
(208) 814-7491
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
M7285
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
804193700
—
ID
01
—
P00654623
MCRR
ID
Enumeration date
06/21/2006
Last updated
12/29/2014
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