Provider Demographics
NPI:1760760912
Name:JOHNSON, ORION JOSEPH (LMT)
Entity Type:Individual
Prefix:MR
First Name:ORION
Middle Name:JOSEPH
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4670 SW WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-0530
Mailing Address - Country:US
Mailing Address - Phone:503-646-8575
Mailing Address - Fax:503-526-0783
Practice Address - Street 1:4670 SW WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-0530
Practice Address - Country:US
Practice Address - Phone:503-646-8575
Practice Address - Fax:503-526-0783
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12409174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist