Provider Demographics
NPI:1578807111
Name:JOHNSON, HARRY RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:RICHARD
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 1:13405 SHORELINE DR SE
Mailing Address - Street 2:
Mailing Address - City:OLALLA
Mailing Address - State:WA
Mailing Address - Zip Code:98359-9618
Mailing Address - Country:US
Mailing Address - Phone:253-857-7348
Mailing Address - Fax:253-857-7363
Practice Address - Street 1:13405 SHORELINE DR SE
Practice Address - Street 2:
Practice Address - City:OLALLA
Practice Address - State:WA
Practice Address - Zip Code:98359-9618
Practice Address - Country:US
Practice Address - Phone:253-857-7348
Practice Address - Fax:253-857-7363
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 00018130207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery