Johansen, Lyndon G
Johansen, Lyndon G is an sole proprietor health care provider with primary practice located at 12658 Se Stark St , Portland OR 97233-1058. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Johansen, Lyndon G can be contacted via phone (503) 256-4018.Contact Information
Primary practice address
12658 Se Stark St
Portland OR 97233-1058
Phone: (503) 256-4018
Fax: (503) 256-6298
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Podiatric Medicine & Surgery Service Providers / Podiatrist | 213E00000X | DP00230 | Oregon |
Profile Details
| NPI number | 1306820402 |
|---|---|
| LBN Legal business name | Johansen, Lyndon G |
| Credentials | Doctor of Podiatric Medicine (DPM) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 1st, 2005 |
| Last updated | Jan 2nd, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1306820402 | NPPES |
| Oregon | MEDICAID | 045653 |
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