Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | M-4536 | ID |
NPI | 1578782496 |
---|---|
Provider Name | Paul W. Johns |
First Address | Blackfoot, ID 83221-5757 |
Second Address | Idaho Falls, ID 83402-1510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 08/07/2007 |