Provider Demographics
NPI:1033220298
Name:JOHNSON, GERMAINE RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:GERMAINE
Middle Name:RICHARD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W STE 210
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60105377207U00000X, 2085R0202X
IDM-12248207U00000X, 2085R0202X
ORMD2082522085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1033220298Medicaid
WA288918OtherLNI PROVIDER ID
WA2006877Medicaid
WAP01020391Medicare PIN
WA288918OtherLNI PROVIDER ID
ID1033220298Medicaid
WA2006877Medicaid
WAG8918768Medicare PIN
ID20004923Medicare PIN
WAG8918719Medicare PIN