Bryan N Johnson, M.D.
Individual provider Active NPI Internal Medicine Physician · Colfax, WA
NPI 1346220670 · NPPES record last updated Oct 14, 2008
Key facts
- NPI
- 1346220670
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- MD00026794 (WA)
- Practice address
- 1210 W Fairview St
Colfax, WA 99111-9552 - Phone
- (509) 397-4717
- NPI assigned
- Jan 20, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00026794 | WA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Colfax of Cascadia, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD00026794 | WA | Yes |
Addresses
Primary practice location
1210 W Fairview St
Colfax, WA 99111-9552
Mailing address
1210 W Fairview St
Colfax, WA 99111-9552
Phone (509) 397-4717
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0032954 | Medicaid | ID | |
| 105789 | Medicaid | WA |
Other providers in Colfax, WA
- Keith Allen Haugen
- Kelly J. Heinlen
- Eric Del Hislop
- Jack Hostetler
- Mark Houghton
- Nathan Johnson
- Jeffrey D Jones
- Irene Kamoye
- Allen Richard Kirkpatrick
- Cassidy A Kobialka
All providers in Colfax, WA · Internal Medicine Physician in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.