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General NPI Number Information
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NPI Number | 1982023479
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Entity Type | Individual
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Provider Name | KEITH JOHNSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/10/2014
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Last Update Date | 02/24/2023
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Provider Practice Location Address
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Address Line | 5 CENTERPOINTE DR
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-8651
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Country | US
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Telephone | 503-606-6355
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Fax | 503-404-4555
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Provider Business Mailing Address
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Address Line | 5 CENTERPOINTE DR STE 400
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-8661
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Country | US
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Telephone | 503-606-6635
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Fax | 581-333-1291
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 9601928-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD187490
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License Number State | OR
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