Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 019902 | LA |
N | 111NI0900X | Internist | 019902 | LA |
Y | 207RP1001X | Pulmonary Disease | 019902 | LA |
NPI | 1033191739 |
---|---|
Provider Name | Joe E Johnson JR. |
First Address | Mandeville, LA 70470-1855 |
Second Address | Covington, LA 70433-4930 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 26/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1970930 | (05) | LA |
F62365 | (02) | |
P00230927 | RAILROAD MEDICARE (01) | LA |