Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 4548 | ND |
NPI | 1013008812 |
---|---|
Provider Name | Robert A Johnson |
First Address | Grand Forks, ND 58206-6002 |
Second Address | Grand Forks, ND 58201-4032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 26/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D77161 | (02) | ND |