Basic Information
| Provider Information | |||||||||
| NPI: | 1265430557 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | LP | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2700 10TH AVE S | ||||||||
| Address2: | STE 200 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352051248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059337838 | ||||||||
| FaxNumber: | 2059330951 | ||||||||
| Practice Location | |||||||||
| Address1: | 2700 10TH AVE S | ||||||||
| Address2: | STE 200 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352051248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059337838 | ||||||||
| FaxNumber: | 2059330951 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2005 | ||||||||
| LastUpdateDate: | 11/04/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 11097 | AL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.