Healthcare Provider Details

I. General information

NPI: 1881836724
Provider Name (Legal Business Name): ERIC ANDERS JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 07/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3377 RIVERBEND DR
SPRINGFIELD OR
97477-8803
US

IV. Provider business mailing address

3377 RIVERBEND DR
SPRINGFIELD OR
97477-8803
US

V. Phone/Fax

Practice location:
  • Phone: 541-222-6160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMD178687
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: