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General NPI Number Information
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NPI Number | 1962462358
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Entity Type | Individual
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Provider Name | RODNEY ELLIS JOHNSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/28/2006
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Last Update Date | 09/02/2010
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Provider Practice Location Address
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Address Line | 328 S STILLAGUAMISH AVE
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City | ARLINGTON
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State | WA
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Zip | 98223-1660
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Country | US
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Telephone | 360-435-6641
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Fax | 360-618-7663
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Provider Business Mailing Address
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Address Line | 25714 38TH AVE NW
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City | STANWOOD
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State | WA
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Zip | 98292-9335
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Country | US
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Telephone | 360-770-1854
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 22830
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License Number State | IA
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