MEDICARE: MR. RYAN CHRISTOPHER JOHNSON D.O.

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	207Q00000X	Family Medicine Physician	OP60214244	WA

General Provider Information

NPI Number	:	1770784019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RYAN CHRISTOPHER JOHNSON D.O.

Provider Business Mailing Address
First Line	:	PO BOX 3360
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3360
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1620 COOPER POINT RD SW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-5736
Country	:	US
Telephone Number	:	360-486-6710
Fax Number	:	360-705-0269

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

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	05/01/2024

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