Provider Demographics
NPI:1245201003
Name:JOHNSON, DENNIS WILLIAM (MD,)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:WILLIAM
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 1:1050 29TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-3416
Mailing Address - Country:US
Mailing Address - Phone:541-926-4828
Mailing Address - Fax:541-926-4891
Practice Address - Street 1:1050 29TH AVE SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-3416
Practice Address - Country:US
Practice Address - Phone:541-926-4828
Practice Address - Fax:541-926-4891
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74423207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine