Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | M-12248 | ID |
N | 207U00000X | Nuclear Medicine Specialist | MD60105377 | WA |
NPI | 1033220298 |
---|---|
Provider Name | Dr. Germaine Richard Johnson |
First Address | Lynnwood, WA 98036-4748 |
Second Address | Lynnwood, WA 98036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 03/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033220298 | (05) | ID |
2006877 | (05) | WA |
288918 | LNI PROVIDER ID (01) | WA |