Provider Demographics
NPI:1053358077
Name:JOHNS, GORDON E (MD)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:E
Last Name:JOHNS
Suffix:
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:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0409
Mailing Address - Country:US
Mailing Address - Phone:360-242-3008
Mailing Address - Fax:360-807-7687
Practice Address - Street 1:2517 NE KRESKY AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-2409
Practice Address - Country:US
Practice Address - Phone:360-748-8632
Practice Address - Fax:360-807-7687
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031242207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1001272Medicaid
WAG9073089OtherMEDICARE WA
WAG9042280OtherMEDICARE
WAG9043091OtherMEDICARE WA
WAG9043088OtherMEDICARE WA
WAG9043087OtherMEDICARE WA
WAG9043090OtherMEDICARE WA
MT180044158OtherRAIL ROAD MEDICARE
OR200977Medicaid
WA8400129Medicaid
OR180040062OtherRAIL ROAD MEDICARE
WA180040059OtherRAIL ROAD MEDICARE
ID180040057OtherRAIL ROAD MEDICARE
AKK150071Medicare PIN
WAG319209205Medicare PIN
WA180040058OtherRAIL ROAD MEDICARE
WAG001056820Medicare PIN
WAG000165119Medicare PIN
ORR018WFBNKDMedicare PIN