Individual
SARA L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
496 SHOUP AVE W, SUITE E, TWIN FALLS, ID 83301
(208) 733-2885
(208) 754-3352
Mailing address
496 SHOUP AVE W, SUITE E, TWIN FALLS, ID 83301
(208) 733-2885
(208) 754-3352
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M4188
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010001118
BLUE SHIELD OF ID
ID
05
—
001484000
—
ID
01
—
57570
BLUE CROSS OF ID
ID
Enumeration date
08/02/2006
Last updated
01/07/2013
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