Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 0101037503 | VA |
NPI | 1003859687 |
---|---|
Provider Name | Stephen M Johnson |
First Address | Bedford, VA 24523-1213 |
Second Address | Bedford, VA 24523-1213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 02/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010286638 | (05) | VA |
1003859687 | (05) | VA |
239950 | ANTHEM (01) | VA |
D27038 | (02) | VA |