Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | R2466 | AR |
NPI | 1013981224 |
---|---|
Provider Name | Ben D Johnson |
First Address | Little Rock, AR 72205 |
Second Address | Little Rock, AR 72205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 14/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104628001 | (05) | AR |
D84188 | (02) |