Provider Demographics
NPI:1336313360
Name:JOHNSON, DAVID P (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 N 27TH ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-0701
Mailing Address - Country:US
Mailing Address - Phone:406-237-8855
Mailing Address - Fax:406-237-8880
Practice Address - Street 1:1027 N 27TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0701
Practice Address - Country:US
Practice Address - Phone:406-237-8855
Practice Address - Fax:406-237-8880
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTS74742Medicare UPIN