Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 0722 | TX |
NPI | 1376531889 |
---|---|
Provider Name | Dr. Robert Marshall Johnson |
First Address | Fort Worth, TX 76132-1500 |
Second Address | Fort Worth, TX 76132-1500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T14062 | (02) |