MEDICARE: MR. ANTHONY REED JOHNSON LMP

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	174400000X	Specialist	MA00002015	WA

General Provider Information

NPI Number	:	1447291133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY REED JOHNSON LMP

Provider Business Mailing Address
First Line	:	15832 34TH AVE NE
Second Line	:
City	:	LAKE FOREST PARK
State	:	WA
Zip	:	98155-6543
Country	:	US
Telephone Number	:	206-361-4700
Fax Number	:

Provider Business Practice Location Address
First Line	:	15832 34TH AVE NE
Second Line	:
City	:	LAKE FOREST PARK
State	:	WA
Zip	:	98155-6543
Country	:	US
Telephone Number	:	206-361-4700
Fax Number	:

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

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	07/08/2007

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