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General NPI Number Information
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NPI Number | 1275514911
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Entity Type | Individual
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Provider Name | LARRY HUGH JOHNSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/09/2005
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Last Update Date | 08/11/2008
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Provider Practice Location Address
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Address Line | 7643 OAK PARK PL NW
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City | BREMERTON
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State | WA
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Zip | 98311-9175
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Country | US
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Telephone | 360-692-2399
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Fax |
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Provider Business Mailing Address
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Address Line | 7643 OAK PARK PL NW
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City | BREMERTON
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State | WA
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Zip | 98311-9175
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Country | US
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Telephone | 360-692-2399
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD00037208
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2001-01071
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35-04-0609-J
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2003-0111
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License Number State | NM
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 36892
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License Number State | KY
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E-4454
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License Number State | AR
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