Individual
DR. COREY S JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1615 DELAWARE ST, LONGVIEW, WA 98632-2367
(360) 501-3500
Mailing address
1115 SE 164TH AVE, DEPT. 358, VANCOUVER, WA 98683-9324
(360) 729-1462
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD60533337
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2020889
—
WA
05
—
500685674
—
OR
Enumeration date
06/07/2010
Last updated
07/14/2015
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