Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD00011699 | WA |
N | 207YS0123X | Facial Plastic Surgeon | MD00011699 | WA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MD00011699 | WA |
N | 208200000X | Surgeon | MD00011699 | WA |
N | 208600000X | Surgeon | MD00011699 | WA |
N | 2086S0122X | Plastic and Reconstructive Surgery | MD00011699 | WA |
NPI | 1437129186 |
---|---|
Provider Name | Gary K Johnson |
First Address | Mount Vernon, WA 98274-4127 |
Second Address | Mount Vernon, WA 98274-4036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 02/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D33846 | (02) | WA |