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Individual
DOMINIC A JOHNSON
Active
Individual
DOMINIC A JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
0101049402
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0633R
BLUE CROSS BLUE SHIELD NC
—
01
—
082480
BLUE CROSS BLUE SHIELD VA
—
01
—
251490
MAMSI/MDIPA
—
01
—
27936
OPTIMA
—
01
—
3900570
OPTIMUM CHOICE
—
01
—
790633R
MEDICAID
NC
Enumeration date
08/15/2006
Last updated
07/08/2007
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