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General NPI Number Information
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NPI Number | 1336328624
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Entity Type | Individual
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Provider Name | JUSTIN THEO JOHNSON D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 11/02/2007
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Last Update Date | 01/27/2017
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Provider Practice Location Address
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Address Line | 1661 HIGHWAY 99 N STE 201
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City | ASHLAND
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State | OR
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Zip | 97520-8900
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Country | US
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Telephone | 541-482-4924
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Fax | 541-488-1732
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Provider Business Mailing Address
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Address Line | 1661 HWY 99 N STE 201
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City | ASHLAND
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State | OR
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Zip | 97520-8900
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Country | US
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Telephone | 541-482-4924
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Fax | 541-488-1732
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | DPOO440
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License Number State | OR
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