Individual
TIMOTHY DONALD JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
931 HIGHLAND BLVD, #3350, BOZEMAN, MT 59715
(406) 586-3309
(406) 522-8498
Mailing address
931 HIGHLAND BLVD, #3350, BOZEMAN, MT 59715
(406) 586-3309
(406) 522-8498
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
26812
WI
207RG0100X
Gastroenterology Physician
4385A
WY
207RG0100X
Gastroenterology Physician
Primary
7982
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000011161
BLUE CROSS BLUE SHIELD
MT
05
—
0019786
—
MT
01
—
S0480698
IRS EIN
—
Enumeration date
10/03/2006
Last updated
03/03/2009
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