Provider Demographics
NPI:1760460612
Name:JOHNSON, JOHN PHILIP (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PHILIP
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 1:2755 COLONIAL DR
Mailing Address - Street 2:SHODAIR HOSPITAL
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4926
Mailing Address - Country:US
Mailing Address - Phone:406-444-7530
Mailing Address - Fax:
Practice Address - Street 1:2755 COLONIAL DR
Practice Address - Street 2:SHODAIR HOSPITAL
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4926
Practice Address - Country:US
Practice Address - Phone:406-444-7530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-01
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7614207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT7614OtherMEDICAL LICENSE NUMBER
MT7614OtherMEDICAL LICENSE NUMBER