Provider Demographics
NPI:1215926985
Name:JOHNSON, JAMES L II (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:JOHNSON
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 CENTRAL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-8624
Mailing Address - Country:US
Mailing Address - Phone:406-896-2478
Mailing Address - Fax:406-896-2491
Practice Address - Street 1:125 W YELLOWSTONE AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-8723
Practice Address - Country:US
Practice Address - Phone:307-527-7129
Practice Address - Fax:307-587-7394
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6172A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT95016OtherBLUE CROSS BLUE SHIELD MT
WY113459100Medicaid
MT0157896Medicaid
WY020049170OtherRAILROAD MEDICARE
WY308210OtherBLUE CROSS BLUE SHIELD
WYW20832Medicare PIN
WYW308537Medicare PIN
MT000085446Medicare PIN
MT0157896Medicaid