Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 35059517 | OH |
NPI | 1093771081 |
---|---|
Provider Name | Ron Michael Johnson |
First Address | Kettering, OH 45429-3474 |
Second Address | Kettering, OH 45429-3474 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 20/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0878699 | (05) | OH |
G08002 | (02) |