Individual
KEVIN M JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
608 NORTHWEST BLVD, SUITE 301, COEUR D ALENE, ID 83814-2174
(208) 676-8346
(208) 664-5345
Mailing address
608 NORTHWEST BLVD, SUITE 301, COEUR D ALENE, ID 83814-2174
(208) 676-8346
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
M7963
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807104000
—
ID
Enumeration date
08/31/2006
Last updated
09/01/2016
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