Individual
LARRY WAYNE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
28691 US HIGHWAY 98, SUITE D1, DAPHNE, AL 36526-7195
(251) 410-6474
Mailing address
PO BOX 907, DAPHNE, AL 36526-0907
(251) 410-6474
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
47-2930554
AL
Other
Enumeration date
02/16/2015
Last updated
02/16/2015
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