Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 266075 | MA |
N | 207R00000X | Internist | 255876 | MA |
N | 111NI0900X | Internist | 255876 | MA |
NPI | 1043650641 |
---|---|
Provider Name | Dr. John Andrew Johnson JR. |
First Address | Yarmouth Port, MA 02675-1757 |
Second Address | Yarmouth Port, MA 02675-1757 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2013 |
Last Update Date | 03/08/2020 |