Individual
DR. SHAE HAL JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
6533 EMERALD STREET, BOISE, ID 83704-8737
(208) 302-5100
(208) 302-5155
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 302-5100
(208) 302-5155
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
5960250-1204
UT
207Q00000X
Family Medicine Physician
DO27594
OR
207Q00000X
Family Medicine Physician
Primary
O-0870
ID
Other
Enumeration date
08/22/2006
Last updated
11/10/2016
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