MEDICARE: ERIC L 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	207P00000X	Emergency Medicine Physician	M4932	ID
2	207PE0005X	Undersea and Hyperbaric Medicine (Emergency Medicine) Physician	M-4932	ID
3	207Q00000X	Family Medicine Physician	M-4932	ID
4	207PE0005X	Undersea and Hyperbaric Medicine (Emergency Medicine) Physician	34447	MT

Other Identifiers

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

General Provider Information

NPI Number	:	1699718023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC L JOHNSON M.D.

Provider Business Mailing Address
First Line	:	915 HIGHLAND BLVD
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59715-6902
Country	:	US
Telephone Number	:	406-414-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	935 HIGHLAND BLVD STE 2180
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59715-6904
Country	:	US
Telephone Number	:	406-414-5512
Fax Number	:

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	03/11/2020

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Directions to “ ERIC L JOHNSON M.D.” Practice Location

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