Healthcare Provider Details

I. General information

NPI: 1487971693
Provider Name (Legal Business Name): STEPHEN C. JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 MONTLAKE BLVD
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

3800 MONTLAKE BLVD PO BOX 50095
SEATTLE WA
98195-0007
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-1534
  • Fax: 206-598-3140
Mailing address:
  • Phone: 206-520-5700
  • Fax: 206-598-3140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD 60301821
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD60301821
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: