MEDICARE: DR. SUSAN H. JOHNSON MD

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	207VG0400X	Gynecology Physician	MD17446	OR
2	207VG0400X	Gynecology Physician	MD60287595	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	160059803	OTHER	OR	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0296298	OTHER	WA	STATE L&I
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073546925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN H. JOHNSON MD

Provider Business Mailing Address
First Line	:	34503 9TH AVE S
Second Line	:	STE 330
City	:	FEDERAL WAY
State	:	WA
Zip	:	98003-8726
Country	:	US
Telephone Number	:	253-383-3695
Fax Number	:	253-661-1987

Provider Business Practice Location Address
First Line	:	34503 9TH AVE S
Second Line	:	STE 330
City	:	FEDERAL WAY
State	:	WA
Zip	:	98003-8726
Country	:	US
Telephone Number	:	253-383-3695
Fax Number	:	253-661-1987

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	09/12/2012

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Directions to “ DR. SUSAN H. JOHNSON MD” Practice Location

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