SHAD CARL JOHNSON

POCATELLO, ID
NPI1114028354
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363AM0700X Physician Assistant, Medical
(Licence: ID  PA-629)
Enumeration Date2006-09-26
Last Update Date2007-07-08
Business Address
-- SHAD CARL JOHNSON PA-C
1151 HOSPITAL WAY BLDG A
POCATELLO, ID 83201-2763
Phone number: 208-232-6616
Mailing Address
-- SHAD CARL JOHNSON PA-C
1151 HOSPITAL WAY BLDG A P.O. BOX 4788
POCATELLO, ID 83201-2763
Phone number: 208-232-6616
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