Healthcare Provider Details

I. General information

NPI: 1528035565
Provider Name (Legal Business Name): ALLEN L. JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 HOSPITAL DR SUITE 200
SEDRO WOOLLEY WA
98284-9315
US

IV. Provider business mailing address

1400 E KINCAID ST ATTN: CREDENTIALING
MOUNT VERNON WA
98274-4127
US

V. Phone/Fax

Practice location:
  • Phone: 360-856-4222
  • Fax: 360-854-2792
Mailing address:
  • Phone: 360-428-2500
  • Fax: 360-428-6485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD00031995
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00031995
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: