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General NPI Number Information
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NPI Number | 1114292034
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Entity Type | Organization
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Legal Business Name | DEBORAH M JOHNSON MD PC
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Dates
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Enumeration Date | 03/09/2012
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Last Update Date | 10/23/2012
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Provider Practice Location Address
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Address Line | 1395 LIBERTY ST SE
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City | SALEM
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State | OR
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Zip | 97302-4276
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Country | US
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Telephone | 503-585-9695
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Fax | 503-581-3960
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Provider Business Mailing Address
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Address Line | 1395 LIBERTY ST SE
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City | SALEM
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State | OR
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Zip | 97302-4276
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Country | US
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Telephone | 503-585-9695
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Fax | 503-581-3960
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEBORAH M JOHNSON
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Credential |
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Telephone | 503-585-9695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MD16845
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License Number State | OR
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