Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 18651 | NE |
Y | 208200000X | Surgeon | 18651 | NE |
Y | 208600000X | Surgeon | 18651 | NE |
N | 2086S0122X | Plastic and Reconstructive Surgery | 18651 | NE |
NPI | 1306895610 |
---|---|
Provider Name | Perry J Johnson |
First Address | Omaha, NE 68198-8102 |
Second Address | Omaha, NE 68198-8102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2006 |
Last Update Date | 29/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47078557586 | (05) | NE |
F40530 | (02) | NE |