Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 1378 | TX |
N | 222Z00000X | Podiatrist | 1378 | TX |
Y | 224P00000X | Prosthetist | 1378 | TX |
NPI | 1417354176 |
---|---|
Provider Name | Woody Johnson |
First Address | Lufkin, TX 75904-3127 |
Second Address | Lufkin, TX 75904-3127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2014 |
Last Update Date | 24/11/2014 |