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NPI Code Detail

MEDICARE: BRIAN LEE JOHNSON M.D.

MEDICARE: BRIAN LEE JOHNSON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianM-9334ID

General Provider Information

NPI Number : 1336138783
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN LEE JOHNSON M.D.
Provider Business Mailing Address
First Line : PO BOX 587
Second Line :
City : TWIN FALLS
State : ID
Zip : 83303-0587
Country : US
Telephone Number : 208-814-7400
Fax Number : 208-814-7491
Provider Business Practice Location Address
First Line : 709 N LINCOLN AVE
Second Line :
City : JEROME
State : ID
Zip : 83338-1851
Country : US
Telephone Number : 208-324-4301
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2005
Last Update Date : 12/20/2013

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