Individual
DALLIN JAY JOHANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2301 ERWIN RD, DURHAM, NC 27705-4699
(919) 684-8111
Mailing address
PO BOX 63362, CHARLOTTE, NC 28263-3362
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
2023-00301
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
NH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/16/2018
Last updated
06/13/2023
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