MEDICARE: HERBERT ANTHONY JOHNSON JR. PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant		WA

General Provider Information

NPI Number	:	1043299647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HERBERT ANTHONY JOHNSON JR. PA-C

Provider Business Mailing Address
First Line	:	2001 PINE WOOD WAY
Second Line	:
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-7321
Country	:	US
Telephone Number	:	360-257-2394
Fax Number	:	360-257-2396

Provider Business Practice Location Address
First Line	:	BEHAVIORAL HEALTH CLINIC, SARP,
Second Line	:	NAVAL HOSPITAL
City	:	OAK HARBOR
State	:	WA
Zip	:	98278-0001
Country	:	US
Telephone Number	:	360-257-2394
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	07/08/2007

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