Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 0101233087 | VA |
NPI | 1184646374 |
---|---|
Provider Name | David Charles Johnson |
First Address | Lansdowne, VA 20176-8102 |
Second Address | Lansdowne, VA 20176-8102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 10/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H43085 | (02) | VA |