Mark C Johnson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

M5266 Issued in ID

Practice address

3301 N Sawgrass Way
Boise, ID 83704-4493

Phone

(208) 375-0862

Fax

(208) 375-2658

NPI assigned

Apr 24, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390435200000",
    "number": "1831155365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 N SAWGRASS WAY",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837044493",
            "telephone_number": "208-375-0862",
            "fax_number": "208-375-2658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MARK",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-24",
        "last_updated": "2014-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M5266",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katrina A Johnson, PA
• Kayla Johnson, LMSW
• Kendra Dee Johnson, LMSW
• Leslie Ann Johnson, M.S.
• Margaret E Johnson, MSN, APRN, PMHNP-BC
• Mary J Johnson, LCPC
• Megan Johnson, RDN, LD
• Melissa Lee Johnson, CD(DONA)
• Michael A Johnson
• Mikenna Morgan Johnson, PHARMD

• Family Medicine Physician in Boise, ID
• Providers in Boise, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.