Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | ME30304 | FL |
NPI | 1083699037 |
---|---|
Provider Name | Dr. Alan D. Johnston |
First Address | Orlando, FL 32806-6100 |
Second Address | Orlando, FL 32806-2134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 03/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D85776 | (02) | FL |