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NPI Code Detail

MEDICARE: DR. LESLIE JOHNSON MD

MEDICARE: DR. LESLIE JOHNSON MD
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
1207R00000XInternal Medicine PhysicianMD25100OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558313817
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LESLIE JOHNSON MD
Provider Business Mailing Address
First Line : 1027 E BURNSIDE ST
Second Line :
City : PORTLAND
State : OR
Zip : 97214-1328
Country : US
Telephone Number : 503-239-8400
Fax Number : 503-239-8406
Provider Business Practice Location Address
First Line : 3175 NE ALOCLEK DR
Second Line :
City : HILLSBORO
State : OR
Zip : 97124-7135
Country : US
Telephone Number : 800-813-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2006
Last Update Date : 09/20/2023

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