Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD0000004294 | TN |
Y | 111NI0900X | Internist | MD0000004294 | TN |
NPI | 1003801143 |
---|---|
Provider Name | Mr. Robert M Johnson |
First Address | Nashville, TN 37203-1551 |
Second Address | Nashville, TN 37203-1551 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3145441 | (05) | TN |
4294 | (05) | KY |
B02117 | (02) | TN |