Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 0101235436 | VA |
NPI | 1043282023 |
---|---|
Provider Name | Dr. Gregory Michael Johnston |
First Address | Dupont, WA 98327-9719 |
Second Address | Tacoma, WA 98431-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2006 |
Last Update Date | 28/07/2008 |