Provider Demographics
NPI:1407145568
Name:JUSTIN T JOHNSON DPM INC.
Entity Type:Organization
Organization Name:JUSTIN T JOHNSON DPM INC.
Other - Org Name:ANKLE AND FOOT SPECIALISTS OF SOUTHERN OREGON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:THEO
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:541-482-4924
Mailing Address - Street 1:1661 HWY 99 N STE 201
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-8900
Mailing Address - Country:US
Mailing Address - Phone:541-482-4924
Mailing Address - Fax:541-488-1732
Practice Address - Street 1:1661 HWY 99 N STE 201
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-8900
Practice Address - Country:US
Practice Address - Phone:541-482-4924
Practice Address - Fax:541-488-1732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00440213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1336328624OtherNPI