Basic Information
| Provider Information | |||||||||
| NPI: | 1215926985 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2820 CENTRAL AVE STE A | ||||||||
| Address2: | |||||||||
| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591028624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4068962478 | ||||||||
| FaxNumber: | 4068962491 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 W YELLOWSTONE AVE | ||||||||
| Address2: | |||||||||
| City: | CODY | ||||||||
| State: | WY | ||||||||
| PostalCode: | 824148723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3075277129 | ||||||||
| FaxNumber: | 3075877394 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2005 | ||||||||
| LastUpdateDate: | 10/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 6172A | WY | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 95016 | 01 | MT | BLUE CROSS BLUE SHIELD MT | OTHER | 113459100 | 05 | WY | MEDICAID | 0157896 | 05 | MT | MEDICAID | 020049170 | 01 | WY | RAILROAD MEDICARE | OTHER | 308210 | 01 | WY | BLUE CROSS BLUE SHIELD | OTHER |