Individual
LYNDON G JOHANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
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
213E00000X
Podiatrist
Primary
DP00230
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
045653
—
OR
Enumeration date
12/01/2005
Last updated
01/02/2013
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