Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RX0202X | Medical Oncology | MD13476 | TN |
Y | 207RX0202X | Medical Oncology | N8409 | TX |
NPI | 1013009422 |
---|---|
Provider Name | David Johnson |
First Address | Dallas, TX 75284-7208 |
Second Address | Dallas, TX 75235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2006 |
Last Update Date | 08/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B04854 | (02) |