Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 23370 | KS |
NPI | 1710937271 |
---|---|
Provider Name | John Christopher Johnson |
First Address | Merriam, KS 66204-2204 |
Second Address | Merriam, KS 66204-2271 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 09/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A98431 | (02) | KS |