Cody Johnson
Physician Assistant in Boise, ID. Individual provider (NPI-1).
NPI number1184392011
StatusActive
Last updated in NPPESNov 30, 2022
Details
- NPI
- 1184392011
- Entity type
- Individual (NPI-1)
- Name
- Cody Johnson
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Sep 3, 2021
- Certification date
- Nov 30, 2022
- Last updated
- Nov 30, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | PA-2399 | ID | Yes |
| 363A00000X | Physician Assistant | – | – |
Practice location
190 E Bannock St Fl 10Boise, ID 83712-6241
Phone 208-381-5500
Mailing address
190 E Bannock StBoise, ID 83712-6241
Other practice locations
407 S Schwartz Ave Ste 101
Farmington, NM 87401-5925
Farmington, NM 87401-5925
Phone 505-609-6595
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All 374 Physician Assistant providers in Boise · All 12,265 providers in Boise
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