MEDICARE: CORY T JOHNSON MD PC

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	207V00000X	Obstetrics & Gynecology Physician	MD24075	OR

General Provider Information

NPI Number	:	1558516005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORY T JOHNSON MD PC

Provider Business Mailing Address
First Line	:	2301 MOUNTAIN VIEW BLVD
Second Line	:	SUITE F
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-1137
Country	:	US
Telephone Number	:	541-850-0490
Fax Number	:	541-850-0499

Provider Business Practice Location Address
First Line	:	3000 BRYANT WILLIAMS DR
Second Line	:	SUITE 100
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-1139
Country	:	US
Telephone Number	:	541-274-2345
Fax Number	:	541-274-4666

Authorized Official
Title or Position	:	MD/CEO
Name	:	CORY TODD JOHNSON
Credential	:	MD
Telephone Number	:	541-274-2345

Provider Enumeration Date	:	11/25/2008
Last Update Date	:	11/25/2008

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