Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MT205068 | PA |
N | 208600000X | Surgeon | MT205068 | PA |
Y | 2086S0129X | Vascular Surgeon | ME142033 | FL |
NPI | 1114369741 |
---|---|
Provider Name | Elizabeth Renee Johnson |
First Address | Miami, FL 33175-3595 |
Second Address | Miami, FL 33175-3595 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2013 |
Last Update Date | 06/12/2021 |