Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | ARNP9287156 | FL |
NPI | 1124560826 |
---|---|
Provider Name | Christopher Johnson |
First Address | Temple Terrace, FL 33617-3611 |
Second Address | Temple Terrace, FL 33617-3611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2016 |
Last Update Date | 26/09/2018 |