MEDICARE: JOHN PHILIP JOHNSON 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	207SG0201X	Clinical Genetics (M.D.) Physician	7614	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7614	OTHER	MT	MEDICAL LICENSE NUMBER

General Provider Information

NPI Number	:	1760460612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN PHILIP JOHNSON MD

Provider Business Mailing Address
First Line	:	2755 COLONIAL DR
Second Line	:	SHODAIR HOSPITAL
City	:	HELENA
State	:	MT
Zip	:	59601-4926
Country	:	US
Telephone Number	:	406-444-7530
Fax Number	:

Provider Business Practice Location Address
First Line	:	2755 COLONIAL DR
Second Line	:	SHODAIR HOSPITAL
City	:	HELENA
State	:	MT
Zip	:	59601-4926
Country	:	US
Telephone Number	:	406-444-7530
Fax Number	:

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

Provider Enumeration Date	:	01/01/2006
Last Update Date	:	07/05/2013

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