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Individual

DR. MIERS C JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
4424 E FLAMINGO AVE, SUITE 110, NAMPA, ID 83687
(208) 288-4700
(208) 288-4720
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 367-5170
(208) 367-5180

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
M-5750
ID
207X00000X
Orthopaedic Surgery Physician
M5750
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010006017
BLUE SHIELD
ID
01
000010006018
BLUE SHIELD
ID
05
002364900
ID
01
200012693
RAILROAD MEDICARE
ID
01
33548
BLUE CROSS
ID
01
57505
BLUE CROSS
ID
Enumeration date
11/02/2005
Last updated
10/22/2014
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