Provider Demographics
NPI:1114049277
Name:JOHNSON, JAMES BROCKBANK (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BROCKBANK
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 1:246 N MISSION ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2004
Mailing Address - Country:US
Mailing Address - Phone:509-662-1955
Mailing Address - Fax:509-662-6695
Practice Address - Street 1:246 N MISSION ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2004
Practice Address - Country:US
Practice Address - Phone:509-662-1955
Practice Address - Fax:509-662-6695
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD135362083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA133136OtherWORKER'S COMPENSATION
WA0180369OtherWORKER'S COMPENSATION IME
WA133136OtherWORKER'S COMPENSATION