Provider Demographics
NPI:1073163622
Name:JOHNSON, ROBERT SCOTT
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:SCOTT
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-0132
Mailing Address - Country:US
Mailing Address - Phone:541-782-8242
Mailing Address - Fax:
Practice Address - Street 1:47815 HIGHWAY 58
Practice Address - Street 2:
Practice Address - City:OAKRIDGE
Practice Address - State:OR
Practice Address - Zip Code:97463-9572
Practice Address - Country:US
Practice Address - Phone:541-782-8304
Practice Address - Fax:541-782-5823
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker