Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 216275 | MA |
Y | 208200000X | Surgeon | MD21930 | ME |
Y | 208600000X | Surgeon | MD21930 | ME |
NPI | 1104896133 |
---|---|
Provider Name | Dr. Scott Raymond Johnson |
First Address | Lewiston, ME 04240-7676 |
Second Address | Lewiston, ME 04240-7690 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0184144 | MASSHEALTH (01) | MA |
216275 | TUFTS HEALTH PLAN (01) | MA |
J25610 | BLUE CROSS (01) | MA |