Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | MD27861 | OR |
NPI | 1043434814 |
---|---|
Provider Name | Dr. Susan Esther Johnson |
First Address | Portland, OR 97232-2686 |
Second Address | Portland, OR 97225-6689 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 30/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2004400 | (05) | WA |
213841 | (05) | OR |