Healthcare Provider Details

I. General information

NPI: 1235300062
Provider Name (Legal Business Name): PAUL ELVIN JOHNSON JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 NW 6TH ST
GRANTS PASS OR
97526-1094
US

IV. Provider business mailing address

1600 NW 6TH ST
GRANTS PASS OR
97526-1094
US

V. Phone/Fax

Practice location:
  • Phone: 541-476-7775
  • Fax:
Mailing address:
  • Phone: 541-476-7775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD28070
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: