Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DN9640 | FL |
NPI | 1003989864 |
---|---|
Provider Name | Dr. Alex Joseph Johnson |
First Address | Tarpon Springs, FL 34688-7204 |
Second Address | Palm Harbor, FL 34684-3600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 08/07/2007 |