Provider Demographics
NPI:1003967456
Name:JOHNSON, CLIFFORD JOHN (DO)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:JOHN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 179TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-5534
Mailing Address - Country:US
Mailing Address - Phone:425-743-5160
Mailing Address - Fax:425-743-5160
Practice Address - Street 1:7320 179TH ST SW
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-5534
Practice Address - Country:US
Practice Address - Phone:425-743-5160
Practice Address - Fax:425-743-5160
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA691207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine