Individual
WESLEY D JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
259 MAIN ST, YARMOUTH, ME 04096
(207) 846-9013
(207) 523-8586
Mailing address
100 FODEN RD W, STE 203, SOUTH PORTLAND, ME 04106
(207) 828-0361
(207) 874-1483
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
015883
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
043392
ANTHEM
—
01
—
2949928
AETNA
—
05
—
309940099
—
ME
Enumeration date
03/18/2006
Last updated
11/17/2010
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