Provider Demographics
NPI:1447291133
Name:JOHNSON, ANTHONY REED (LMP)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:REED
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:MR
Other - First Name:REED
Other - Middle Name:SVADESH
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:15832 34TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98155-6543
Mailing Address - Country:US
Mailing Address - Phone:206-361-4700
Mailing Address - Fax:
Practice Address - Street 1:15832 34TH AVE NE
Practice Address - Street 2:
Practice Address - City:LAKE FOREST PARK
Practice Address - State:WA
Practice Address - Zip Code:98155-6543
Practice Address - Country:US
Practice Address - Phone:206-361-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00002015174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist