Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 7614 | MT |
NPI | 1760460612 |
---|---|
Provider Name | John Philip Johnson |
First Address | Helena, MT 59601-4926 |
Second Address | Helena, MT 59601-4926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/01/2006 |
Last Update Date | 05/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7614 | MEDICAL LICENSE NUMBER (01) | MT |
F08725 | (02) | MT |