Johnson, David A

Johnson, David A is an sole proprietor health care provider with primary practice located at 775 Pole Line Rd W Suite 213, Twin Falls ID 83301-5814. He recently has only one registered license in Allopathic & Osteopathic Physicians / Vascular Surgery, which is considered as his primary health care specialty. Johnson, David A can be contacted via phone (208) 814-8475.

Contact Information

Primary practice address
775 Pole Line Rd W Suite 213 Twin Falls ID 83301-5814
Phone: (208) 814-8475
Fax: (208) 734-4177
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Vascular Surgery 2086S0129X 29904 Mississippi
Allopathic & Osteopathic Physicians / Vascular Surgery 2086S0129X M6776 Idaho

Profile Details

NPI number 1922035104
LBN Legal business name Johnson, David A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 26th, 2006
Last updated Mar 21st, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922035104 NPPES
Idaho Other P00899554 MCRR
Idaho MEDICAID 003760400 MCRR

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