MEDICARE: PAUL W. JOHNS 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
1	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	M-4536	ID

General Provider Information

NPI Number	:	1578782496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL W. JOHNS MD

Provider Business Mailing Address
First Line	:	365 N 200 W
Second Line	:
City	:	BLACKFOOT
State	:	ID
Zip	:	83221-5757
Country	:	US
Telephone Number	:	208-785-6309
Fax Number	:

Provider Business Practice Location Address
First Line	:	1955 FREMONT AVE
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83402-1510
Country	:	US
Telephone Number	:	208-526-0404
Fax Number	:

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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