Individual
MATTHEW ALAN JOHANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
0101258243
VA
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
35.129257
OH
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
D79334
MD
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
TP268
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/29/2010
Last updated
07/14/2016
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