Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NI0013X | Independent Medical Examiner | 20642 | CA |
Y | 111NX0100X | Occupational Health | 20642 | CA |
NPI | 1457783011 |
---|---|
Provider Name | Dr. Thomas Edward Johnson |
First Address | El Dorado Hills, CA 95762-3927 |
Second Address | El Dorado Hills, CA 95762-3927 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2013 |
Last Update Date | 06/08/2013 |