MEDICARE: DR. RODNEY ELLIS 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	207X00000X	Orthopaedic Surgery Physician	22830	IA

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	:	1962462358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RODNEY ELLIS JOHNSON M.D.

Provider Business Mailing Address
First Line	:	25714 38TH AVE NW
Second Line	:
City	:	STANWOOD
State	:	WA
Zip	:	98292-9335
Country	:	US
Telephone Number	:	360-770-1854
Fax Number	:

Provider Business Practice Location Address
First Line	:	328 S STILLAGUAMISH AVE
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-1660
Country	:	US
Telephone Number	:	360-435-6641
Fax Number	:	360-618-7663

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	09/02/2010

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