Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | MD 60301821 | WA |
Y | 2081S0010X | Sports Medicine | MD60301821 | WA |
Y | 213ES0000X | Sports Medicine | MD60301821 | WA |
NPI | 1487971693 |
---|---|
Provider Name | Stephen C. Johnson |
First Address | Seattle, WA 98195-0007 |
Second Address | Seattle, WA 98195-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2010 |
Last Update Date | 22/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1487971693 | (05) | WA |