NPI 1114000130

Jedidiah E. Johnson, HSIDC

Practitioner Independent Duty Corpsman Homer, AK

Practice location

Address: 4688 Homer Spit Rd, Homer, AK 99603-8001
Phone: (360) 567-8238
Mailing address: 4688 Homer Spit Rd Uscgc Hickory, Homer, AK 99603

Registered specialties (2)

Independent Duty Corpsman Primary

Other Service Providers Taxonomy 1710I1002X

Other Military Health Care Provider providers in Alaska →

Other Technician

Technologists, Technicians & Other Technical Service Providers Taxonomy 247200000X

Other Technician, Other providers in Alaska →

Registry record

NPI: 1114000130
Entity type: Individual
Sex (as registered): Male
NPI issued: 23 Oct 2006
Record last updated: 8 Oct 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.