Individual
JORDAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
990 NW CIRCLE BLVD STE 102, CORVALLIS, OR 97330-1967
(541) 768-5486
Mailing address
PO BOX 1189, CORVALLIS, OR 97339-1189
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA201748
OR
Other
Enumeration date
08/26/2020
Last updated
11/10/2020
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