Organization
MOUNTAIN TELERAD, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHEAL BRENT JOHNSON D.O. (OWNER)
(208) 455-7482
Entity
Organization
Contact information
Practice address
4519 ENTERPRISE WAY, CALDWELL, ID 83605
(208) 455-7482
(208) 455-7538
Mailing address
141 VICTOR GUST DR, MOUNTAIN HOME, ID 83647-1654
(208) 580-9524
Taxonomy
Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
Primary
—
—
Other
Enumeration date
08/17/2007
Last updated
08/17/2007
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