| Doctor Name: | WAYNE CLAIR JOHNSON |
| NPI Number: | 1083785760 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 3115 N Govt Way Suite #7 Coeur D Alene, ID - 838153790 |
| Business Phone Number: | 2087620797 |
| Business Fax Number: | 2087620791 |
| Mailing Address: | 3115 N Government Way, Suite #7 COEUR D ALENE |
| State: | ID |
| Postal Code: | 83815 |
| Phone Number: | 2087620797 |
| Fax Number: | 2087620791 |
| NPI Enumeration Date: | 11/13/2006 |
| NPI Last Update Date: | 01/24/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |