Provider Demographics
NPI:1184623902
Name:JOHNSON, MICHAEL LEE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:990 SYLVAN WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-2851
Mailing Address - Country:US
Mailing Address - Phone:360-479-3657
Mailing Address - Fax:360-373-7616
Practice Address - Street 1:990 SYLVAN WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-2851
Practice Address - Country:US
Practice Address - Phone:360-479-3657
Practice Address - Fax:360-373-7616
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00023534207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA46013OtherVICTIMS OF CRIME
WA050039619OtherRAILROAD MEDICARE
WA91084721504OtherKPS
WAJO3238OtherREGENCE BLUE SHIELD
WA1015023Medicaid
WA910847215OtherPREMERA BLUE CROSS
WA016487001OtherGROUP HEALTH CORP
WA46013OtherLABOR AND INDUSTRIES
WA910847215OtherUNIFORM MEDICAL
WA910847215OtherPREMERA BLUE CROSS
WA050039619OtherRAILROAD MEDICARE