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General NPI Number Information
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NPI Number | 1437129186
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Entity Type | Individual
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Provider Name | GARY K JOHNSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 11/02/2021
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Provider Practice Location Address
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Address Line | 118 S 12TH ST
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City | MOUNT VERNON
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State | WA
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Zip | 98274-4036
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Country | US
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Telephone | 360-336-2178
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Fax | 360-336-1995
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Provider Business Mailing Address
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Address Line | 1400 E KINCAID ST
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City | MOUNT VERNON
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State | WA
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Zip | 98274-4127
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Country | US
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Telephone | 360-336-2178
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Fax | 360-336-1674
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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 | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | MD00011699
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207YX0602X
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Taxonomy Name | Otolaryngic Allergy Physician
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License Number | MD00011699
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | MD00011699
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | MD00011699
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License Number State | WA
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Taxonomy #5
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | MD00011699
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License Number State | WA
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Taxonomy #6
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | MD00011699
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License Number State | WA
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