Lyndon G Johansen Dpm Pc in Portland - Podiatric
Lyndon G Johansen Dpm Pc - NPI 1093993453
Lyndon G Johansen Dpm Pc is a Podiatric in Portland, Oregon. Lyndon G Johansen Dpm Pc practices all healthcare services and medical treatments related to Podiatric. The NPI Number for Lyndon G Johansen Dpm Pc is 1093993453. The last update date is 2011-10-05.
Lyndon G Johansen Dpm Pc's current location address is 12658 Se Stark St, Portland, Oregon. You can contact this provider via phone number 5032564018 and fax number 5032566298. The mailing address for Lyndon G Johansen Dpm Pc is 12658 Se Stark St, Portland, Oregon. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Lyndon G Johansen Dpm Pc |
|---|---|
| Address | 12658 Se Stark St, Portland, Oregon |
| Phone Number | 5032564018 |
| Fax Number | 5032566298 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | OWNER |
|---|---|
| Authorized Official Name | Johansen George Lyndon |
| Credentials | D.P.M. |
| Telephone Number | 5032564018 |
NPI Number Detail
| NPI Number | 1093993453 |
|---|---|
| Provider Enumeration Date | 2008-02-07 |
| Last Updated Date | 2011-10-05 |
Provider Mailing Address Detail
| Address | 12658 Se Stark St |
|---|---|
| City | Portland |
| State | Oregon (OR) |
| Post Code | 972331058 |
| Phone Number | 5032564018 |
| Fax Number | 5032566298 |
Provider's Primary Taxonomy Detail
| Speciality | Podiatric |
|---|---|
| Taxonomy | 261Qp1100X |
|
Definition: Provides conservative and surgical foot and ankle care. |
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What is the unique 10-digit identification code assigned to Lyndon G Johansen Dpm Pc by the Centers for Medicare & Medicaid Services?
The Lyndon G Johansen Dpm Pc has been issued the NPI (National Provider Identifier) 1093993453, which serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Where is the Lyndon G Johansen Dpm Pc located?
The Lyndon G Johansen Dpm Pc is located at 12658 Se Stark St, Portland, OR 972331058.
What is Lyndon G Johansen Dpm Pc's specialized area of practice, and what is the corresponding taxonomy classification code for this field?
The Lyndon G Johansen Dpm Pc's specialized field of practice is Podiatric, and the corresponding taxonomy code that categorizes this area of specialization is 261Qp1100X.
On what date did the Centers for Medicare & Medicaid Services originally issue the 1093993453 to Lyndon G Johansen Dpm Pc?
The Centers for Medicare & Medicaid Services originally issued the 1093993453 to Lyndon G Johansen Dpm Pc on 2008-02-07.
As of what date was the information regarding Lyndon G Johansen Dpm Pc, such as address, specialty, and other details, last verified and confirmed to be up-to-date?
The information related to Lyndon G Johansen Dpm Pc, including its address, specialty, and other relevant details, was last verified and confirmed to be up-to-date on 2011-10-05.