MEDICARE: ANDREW 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	2084P0800X	Psychiatry Physician	M-15572	ID

General Provider Information

NPI Number	:	1811491756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW JOHNSON MD

Provider Business Mailing Address
First Line	:	419 S 8TH ST STE 303
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-5523
Country	:	US
Telephone Number	:	208-241-7475
Fax Number	:

Provider Business Practice Location Address
First Line	:	419 S 8TH ST STE 303
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-5523
Country	:	US
Telephone Number	:	208-241-7475
Fax Number	:	208-847-7005

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

Provider Enumeration Date	:	03/23/2018
Last Update Date	:	03/10/2026

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