Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 32377 | KY |
N | 208200000X | Surgeon | 32377 | KY |
N | 208600000X | Surgeon | 32377 | KY |
NPI | 1366400392 |
---|---|
Provider Name | Thomas Donaldson Johnston |
First Address | Lexington, KY 40508-3215 |
Second Address | Lexington, KY 40536-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64323777 | (05) | KY |
C17536 | (02) |