MEDICARE: DR. HARRY RICHARD JOHNSON M.D.

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	207X00000X	Orthopaedic Surgery Physician	MD 00018130	WA

General Provider Information

NPI Number	:	1578807111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARRY RICHARD JOHNSON M.D.

Provider Business Mailing Address
First Line	:	13405 SHORELINE DR SE
Second Line	:
City	:	OLALLA
State	:	WA
Zip	:	98359-9618
Country	:	US
Telephone Number	:	253-857-7348
Fax Number	:	253-857-7363

Provider Business Practice Location Address
First Line	:	13405 SHORELINE DR SE
Second Line	:
City	:	OLALLA
State	:	WA
Zip	:	98359-9618
Country	:	US
Telephone Number	:	253-857-7348
Fax Number	:	253-857-7363

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

Provider Enumeration Date	:	11/20/2012
Last Update Date	:	11/20/2012

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