Provider Demographics
NPI:1497863005
Name:JOHNSON, COURTNEY ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:ROSE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:ROSE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3623 SW ALASKA ST STE 7
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-2732
Mailing Address - Country:US
Mailing Address - Phone:206-278-3930
Mailing Address - Fax:360-474-3947
Practice Address - Street 1:3623 SW ALASKA ST, SUITE 7
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126
Practice Address - Country:US
Practice Address - Phone:360-440-8376
Practice Address - Fax:360-474-3927
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037773207Q00000X
WA00037773207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA176500OtherL&I
WA8270597Medicaid
5319WIOtherREGENCE BLUESHIELD
7094279OtherAETNA
5319WIOtherREGENCE BLUESHIELD
WA176500OtherL&I