Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 32454 | AL |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 32454 | AL |
NPI | 1275748428 |
---|---|
Provider Name | Michael David Johnson |
First Address | Birmingham, AL 35205-5327 |
Second Address | Birmingham, AL 35205-5327 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 11/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0293209 | L&I (01) | WA |
1275748428 | (05) | WA |
8909603 | (02) | WA |