Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 06609 | IA |
NPI | 1619915816 |
---|---|
Provider Name | Dr. Michael L Johnson JR. |
First Address | Cedar Falls, IA 50613-7410 |
Second Address | Cedar Falls, IA 50613-7410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 18/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0289694 | (05) | IA |
U95261 | (02) | IA |