1861463788 NPI number — DR. ROBERT LANCE JOHANSEN M.D.

Table of content: DR. ROBERT LANCE JOHANSEN M.D. (NPI 1861463788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861463788 NPI number — DR. ROBERT LANCE JOHANSEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHANSEN
Provider First Name:
ROBERT
Provider Middle Name:
LANCE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHANSEN
Provider Other First Name:
ROBERT
Provider Other Middle Name:
LANCE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1861463788
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2781 CT SWIZTER SR DR
Provider Second Line Business Mailing Address:
SUITE 310
Provider Business Mailing Address City Name:
BILOXI
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39531-4535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-328-2400
Provider Business Mailing Address Fax Number:
228-328-4200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2781 CT SWITZER SENIOR DRIVE
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
BILOXI
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39531-4536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-328-2400
Provider Business Practice Location Address Fax Number:
228-328-4200
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207XS0114X , with the licence number:  14698 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5707330001 . This is a "NSC" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 00116678 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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