| NPI | 1023780376 |
|---|---|
| Other Name | CORY AVERILL JOHNSON |
| Entity Type | Organization |
| Authorized Contact | CORY AVERILL JOHNSON Owner/Provider 208-667-9762 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Enumeration Date | 2021-10-04 |
| Last Update Date | 2021-10-04 |