Individual
BRADLEY LOYAL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
401 W POPLAR ST, RADIOLOGY, WALLA WALLA, WA 99362-2846
(509) 522-5790
(509) 522-5744
Mailing address
PO BOX 34439, SEATTLE, WA 98124-1439
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD00027313
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150804
—
OR
05
—
1720195068
—
WA
Enumeration date
08/24/2006
Last updated
03/22/2012
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