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General NPI Number Information
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NPI Number | 1346306974
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Entity Type | Organization
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Legal Business Name | SARA L. JOHNSON, MD
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 496 SHOUP AVE W SUITE E
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City | TWIN FALLS
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State | ID
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Zip | 83301-5043
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Country | US
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Telephone | 208-733-2885
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Fax | 208-734-3352
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Provider Business Mailing Address
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Address Line | 496 SHOUP AVE W SUITE E
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City | TWIN FALLS
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State | ID
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Zip | 83301-5043
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Country | US
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Telephone | 208-733-2885
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Fax | 208-734-3352
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Authorized Official
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Title or Position | OWNER
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Name | DR. SARA JOHNSON
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Credential | M.D.
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Telephone | 208-733-2885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | M4188
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License Number State | ID
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