Provider Demographics
NPI:1396705166
Name:JOHNSON, FRANK LEWIS (MD)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:LEWIS
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 1:6410 BUFFALOBERRY LN
Mailing Address - Street 2:
Mailing Address - City:BOZMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718
Mailing Address - Country:US
Mailing Address - Phone:406-586-1857
Mailing Address - Fax:360-475-4512
Practice Address - Street 1:ONE BOONE ROAD
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-1898
Practice Address - Country:US
Practice Address - Phone:360-475-4379
Practice Address - Fax:360-475-4512
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0050184Medicaid
MT0050184Medicaid
D93537Medicare UPIN