Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 188 | SD |
Y | 213E00000X | Podiatrist | 188 | SD |
Y | 222Z00000X | Podiatrist | 188 | SD |
NPI | 1699794693 |
---|---|
Provider Name | Rylan J Johnson |
First Address | Rapid City, SD 57701-6000 |
Second Address | Rapid City, SD 57701-6003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 06/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V09872 | (02) |