person
Shad Carl Johnson, PA-C
Medical Physician Assistant in Pocatello, Idaho
NPI 1114028354

Shad Carl Johnson is a Medical Physician Assistant based in Pocatello, ID and is specialized in Medical. Shad Carl Johnson practices in Pocatello, ID and has the professional credentials of PA-C. The NPI Number for Shad Carl Johnson is 1114028354 and holds a License No. PA-629 (Idaho).

The current practice location address for Shad Carl Johnson is 1151 Hospital Way Bldg A, Pocatello, ID and can be reached out via phone at 208-232-6616 and via fax at 208-232-6618.

Location: 1151 Hospital Way Bldg A, Pocatello, ID, 83201-2763
person
Provider Profile Details
NPI Number
1114028354
Provider Name
Shad Carl Johnson
Credential
PA-C
Provider Entity Type
Individual
Gender
Male
Address
1151 Hospital Way Bldg A, Pocatello, ID, 83201-2763
Phone Number
208-232-6616
Fax Number
208-232-6618
Provider Enumeration Date
09/26/2006
Last Update Date
03/08/2024
institution
Provider Business Practice Location Address Details
Address
1151 Hospital Way Bldg A
City
State
Zip
83201-2763
Phone Number
208-232-6616
Fax Number
208-232-6618
person
Provider Business Mailing Address Details
Address
1151 Hospital Way Bldg A
City
State
Zip
83201-2763
Phone Number
208-232-6616
Fax Number
208-232-6618
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
License No.
PA-629 (Idaho)
Definition
Definition to come...
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