Individual
DR. KEVIN RAYMOND JOHNSON I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1510 DIVISION ST, STE 210, OREGON CITY, OR 97045-1599
(503) 723-6525
(503) 723-6508
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD16564
OR
2086S0129X
Vascular Surgery Physician
MD16564
OR
208C00000X
Colon & Rectal Surgery Physician
MD16564
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128541
—
OR
01
—
P00924574
RR MEDICARE
OR
Enumeration date
06/22/2005
Last updated
06/27/2011
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