Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 0101230493 | VA |
NPI | 1801872262 |
---|---|
Provider Name | Dr. Lester S Johnson |
First Address | Virginia Beach, VA 23462-6563 |
Second Address | Virginia Beach, VA 23462-6563 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2005 |
Last Update Date | 07/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
139178 | BCBS (01) | VA |
300116467 | RR MEDICARE (01) | VA |
35289 | OPTIMA (01) | VA |
35289 | SENTARA (01) | VA |
7235348 | (05) | VA |
89064PJ | (05) | NC |
H22925 | (02) |