Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | F8525 | TX |
NPI | 1255343133 |
---|---|
Provider Name | Dr. Alfred R. Johnson |
First Address | Richardson, TX 75080-8105 |
Second Address | Richardson, TX 75080-8105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 04/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A67203 | (02) | TX |