Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 59619 | MA |
Y | 208600000X | Surgeon | 59619 | MA |
N | 2086S0102X | Surgical Critical Care | 59619 | MA |
N | 2086X0206X | Surgical Oncologist | 59619 | MA |
NPI | 1346546512 |
---|---|
Provider Name | Dr. Olaf Kenneth Johnson JR. |
First Address | Blantyre, SOUTHERN PROVINCE CENTRAL AFRICA |
Second Address | Blantyre, SOUTHERN PROVINCE CENTRAL AFRICA |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2011 |
Last Update Date | 04/02/2011 |