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General NPI Number Information
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NPI Number | 1558516005
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Entity Type | Organization
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Legal Business Name | CORY T JOHNSON MD PC
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Dates
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Enumeration Date | 11/25/2008
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Last Update Date | 11/25/2008
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Provider Practice Location Address
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Address Line | 3000 BRYANT WILLIAMS DR SUITE 100
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City | KLAMATH FALLS
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State | OR
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Zip | 97601-1139
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Country | US
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Telephone | 541-274-2345
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Fax | 541-274-4666
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Provider Business Mailing Address
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Address Line | 2301 MOUNTAIN VIEW BLVD SUITE F
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City | KLAMATH FALLS
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State | OR
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Zip | 97601-1137
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Country | US
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Telephone | 541-850-0490
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Fax | 541-850-0499
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Authorized Official
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Title or Position | MD/CEO
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Name | CORY TODD JOHNSON
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Credential | MD
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Telephone | 541-274-2345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD24075
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License Number State | OR
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