Individual
ELLIS W JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
527 2ND ST, WOODLAND, WA 98674-8486
(360) 225-8911
(360) 225-8547
Mailing address
PO BOX 821350, VANCOUVER, WA 98682-0030
(360) 687-5221
(360) 666-0466
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00023663
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016647
—
OR
01
—
105322
DEPT OF L&I
WA
05
—
1087113
—
WA
Enumeration date
08/21/2006
Last updated
07/08/2007
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