Individual
DR. DERICK MICHAEL JOHNSON
Active
Individual
DR. DERICK MICHAEL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
0102202412
VA
207X00000X
Orthopaedic Surgery Physician
Primary
L1206639
MI
390200000X
Student in an Organized Health Care Education/Training Program
58.001489
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0102202412
LICENSE
VA
Enumeration date
07/25/2008
Last updated
07/23/2014
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