Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | D9680 | TX |
N | 213EG0000X | General Practice | D9680 | TX |
N | 1223P0106X | Oral and Maxillofacial Pathology | D9680 | TX |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | D9680 | TX |
N | 1223X0008X | Oral and Maxillofacial Radiology | D9680 | TX |
NPI | 1780650721 |
---|---|
Provider Name | Dr. Robert Paul Johnson |
First Address | San Antonio, TX 78229-3735 |
Second Address | San Antonio, TX 78229-3735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 26/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
079997501 | (05) | TX |
079997502 | (05) | TX |