Individual
DAVID A JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
775 POLE LINE RD W, SUITE 213, TWIN FALLS, ID 83301-5814
(208) 814-8475
(208) 734-4177
Mailing address
PO BOX 587, TWIN FALLS, ID 83303-0587
(208) 814-7400
(208) 814-7491
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
29904
MS
2086S0129X
Vascular Surgery Physician
Primary
M6776
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003760400
—
ID
01
—
P00899554
MCRR
ID
Enumeration date
06/26/2006
Last updated
03/21/2022
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