Individual
MR. TYLER ELLIOT JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
342 DOVER CT, VIRGINIA BEACH, VA 23454-4253
(415) 672-2782
Mailing address
342 DOVER CT, VIRGINIA BEACH, VA 23454-4253
(415) 672-2782
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
B8829445
CA
Other
Enumeration date
02/13/2012
Last updated
02/13/2012
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