Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | L4010 | TX |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | L4010 | TX |
N | 207XS0106X | Orthopaedic Hand Surgeon | L4010 | TX |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | L4010 | TX |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | L4010 | TX |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | L4010 | TX |
N | 207XX0801X | Orthopaedic Trauma Surgeon | L4010 | TX |
N | 208200000X | Surgeon | L4010 | TX |
N | 208600000X | Surgeon | L4010 | TX |
N | 2086S0127X | Trauma Surgeon | L4010 | TX |
NPI | 1558369058 |
---|---|
Provider Name | Dr. Keith R Johnson |
First Address | El Paso, TX 79902 |
Second Address | El Paso, TX 79902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 07/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
151853205 | (05) | TX |
8F20596 | INDIVIDUAL PTAN (01) | TX |
H60430 | (02) | TX |