Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | MD25201 | DC |
NPI | 1255321535 |
---|---|
Provider Name | Gerald S Johnston |
First Address | Rockville, MD 20854-2931 |
Second Address | Washington, DC 20010-2976 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D77883 | (02) |