Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 24119 | IA |
NPI | 1174505499 |
---|---|
Provider Name | Dr. James Clyde Johns JR. |
First Address | Cedar Rapids, IA 52402-5328 |
Second Address | Cedar Rapids, IA 52402-5328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 24/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
17027 | BLUE CROSS/BLUE SHIELD (01) | IA |
3072694 | (05) | IA |
E92856 | (02) | IA |