MEDICARE: SUSAN JOHNSON, MD LLC

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	207VG0400X	Gynecology Physician	MD17446	OR

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	:	1952330631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN JOHNSON, MD LLC

Provider Business Mailing Address
First Line	:	PO BOX 23200
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97281-3200
Country	:	US
Telephone Number	:	503-345-9339
Fax Number	:	503-345-9339

Provider Business Practice Location Address
First Line	:	2209 LLOYD CTR
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-1315
Country	:	US
Telephone Number	:	503-345-9339
Fax Number	:	503-345-9339

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. SUSAN HARRINGTON JOHNSON
Credential	:	MD
Telephone Number	:	503-345-9339

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	04/14/2011

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