Provider Demographics
NPI:1710229851
Name:JOHNSON, SKYLAR HUGHES
Entity type:Individual
Prefix:MR
First Name:SKYLAR
Middle Name:HUGHES
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 STAFFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6706
Mailing Address - Country:US
Mailing Address - Phone:406-579-3048
Mailing Address - Fax:
Practice Address - Street 1:226 STAFFORD AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6706
Practice Address - Country:US
Practice Address - Phone:406-579-3048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0058924207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine