1770560179 NPI number — DR. LUTHER BRENT JOHANSEN M.D.

Table of content: DR. LUTHER BRENT JOHANSEN M.D. (NPI 1770560179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770560179 NPI number — DR. LUTHER BRENT JOHANSEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHANSEN
Provider First Name:
LUTHER
Provider Middle Name:
BRENT
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770560179
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
U.S. ARMY HOSPITAL
Provider Second Line Business Mailing Address:
ATTN:MCEUL-PSY
Provider Business Mailing Address City Name:
LANDSTUHL/KIRCHBERG
Provider Business Mailing Address State Name:
RHINELAND-PFALZ
Provider Business Mailing Address Postal Code:
66849
Provider Business Mailing Address Country Code:
DE
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
U.S. ARMY HOSPITAL
Provider Second Line Business Practice Location Address:
ATTN:MCEUL-PSY
Provider Business Practice Location Address City Name:
LANDSTUHL/KIRCHBERG
Provider Business Practice Location Address State Name:
RHINELAND-PFALZ
Provider Business Practice Location Address Postal Code:
66849
Provider Business Practice Location Address Country Code:
DE
Provider Business Practice Location Address Telephone Number:
011496371867276
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2005

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: 2084P0802X , with the licence number:  D41065 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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