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NPI Code Detail

MEDICARE: JAMES B JOHNSEN D.M.D.

MEDICARE: JAMES B JOHNSEN D.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
1208D00000XGeneral Practice Physician5676OR

General Provider Information

NPI Number : 1588662738
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES B JOHNSEN D.M.D.
Provider Business Mailing Address
First Line : 14125 SW FARMINGTON RD
Second Line :
City : BEAVERTON
State : OR
Zip : 97005-2567
Country : US
Telephone Number : 503-646-4432
Fax Number :
Provider Business Practice Location Address
First Line : 14125 SW FARMINGTON RD
Second Line :
City : BEAVERTON
State : OR
Zip : 97005-2567
Country : US
Telephone Number : 503-646-4432
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2005
Last Update Date : 07/08/2007

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