Most Relevant Information
Provider Data
| NPI Number: | 1003440827 |
| Provider Name: | BO JOHNSON |
| Entity Type: | Individual |
| Taxonomy Code: | 2255A2300X |
| Specialty: | Specialist/Technologist |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/02/2020 |
| Last Updated: | 03/02/2020 |
Provider Practice Location
345 MONMOUTH AVE N
MONMOUTH
OR
973611329
Practice Location Phone/Fax
| Phone: | 5038388343 |
| Fax: |
Provider Mailing Location
427 KESTREL ST N
KEIZER
OR
973035311
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |