Individual
MR. BEN DOUGLAS JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
205 N PHOENIX RD STE 430, PHOENIX, OR 97535-9108
(541) 778-4517
(541) 833-0995
Mailing address
205 N PHOENIX RD STE 430, PHOENIX, OR 97535-9108
(541) 778-4517
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00825
OR
363AS0400X
Surgical Physician Assistant
PA00825
OR
Other
Enumeration date
11/17/2006
Last updated
02/09/2024
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