Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | H2497 | TX |
NPI | 1013024181 |
---|---|
Provider Name | Wendell Johnson |
First Address | San Antonio, TX 78229-3901 |
Second Address | San Antonio, TX 78229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 05/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101564604 | (05) | TX |
101564605 | CSHCN (01) | TX |