Organization
LYNDON G JOHANSEN DPM PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNDON GEORGE JOHANSEN D.P.M. (OWNER)
(503) 256-4018
Entity
Organization
Contact information
Practice address
12658 SE STARK ST, PORTLAND, OR 97233-1058
(503) 256-4018
(503) 256-6298
Mailing address
12658 SE STARK ST, PORTLAND, OR 97233-1058
(503) 256-4018
(503) 256-6298
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
—
—
Other
Enumeration date
02/07/2008
Last updated
10/05/2011
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