Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 36746 | NC |
NPI | 1083690572 |
---|---|
Provider Name | Dr. Michael Johnson |
First Address | Morrisville, NC 27560-8442 |
Second Address | Goldsboro, NC 27534-9458 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2005 |
Last Update Date | 10/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040009804 | RETIRED RAILROAD MEDICARE (01) | NC |
46388 | BCBSNC (01) | NC |
8946388 | (05) | NC |
E48577 | (02) | NC |