Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | MD023199E | PA |
NPI | 1033100623 |
---|---|
Provider Name | Douglas E Johnson |
First Address | Allentown, PA 18103-6212 |
Second Address | Allentown, PA 18103-6212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 20/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0687874 | (05) | PA |