Individual
BRIAN CHRISTOPHER JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
961
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2251PA
—
SC
01
—
961
STATE LICENSE NUMBER
SC
01
—
P0161435
RR MEDICARE
SC
Enumeration date
08/12/2006
Last updated
04/19/2016
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