Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0106X | Orthopaedic Hand Surgeon | 12294965-1205 | UT |
Y | 207XS0106X | Orthopaedic Hand Surgeon | A87693 | CA |
NPI | 1144203258 |
---|---|
Provider Name | Toby Johnson |
First Address | Provo, UT 84604-3305 |
Second Address | Fresno, CA 93720-3305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 01/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0196688 | STATE OF WASHINGTON (01) | CA |
I33632 | (02) | CA |
P00276609 | RAILROAD MEDICARE (01) | CA |