Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0002X | Hospice and Palliative Medicine | 25543 | KY |
Y | 207RH0003X | Hematology & Oncology | 25543 | KY |
NPI | 1073512133 |
---|---|
Provider Name | Dana Allen Johnson |
First Address | London, KY 40743-0936 |
Second Address | Ashland, KY 41101-2845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 02/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0829787 | OHIO MEDICAID (01) | OH |
64255433 | (05) | KY |
C76800 | (02) |