MEDICARE: MARK A JOHNSON DO

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
1	207Q00000X	Family Medicine Physician	O-0583	ID
2	207Q00000X	Family Medicine Physician	OL20000133	WA

General Provider Information

NPI Number	:	1376707034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK A JOHNSON DO

Provider Business Mailing Address
First Line	:	1524 W CAYUSE CREEK DR
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-4795
Country	:	US
Telephone Number	:	208-937-8372
Fax Number	:	208-616-1606

Provider Business Practice Location Address
First Line	:	1524 W CAYUSE CREEK DR
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-4795
Country	:	US
Telephone Number	:	208-937-8372
Fax Number	:	208-616-1606

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2008
Last Update Date	:	05/18/2026

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Directions to “ MARK A JOHNSON DO” Practice Location

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