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Contact Information

LYNDON G JOHANSEN, DPM
12658 SE STARK ST
PORTLAND, OR97233-1058
 Phone: 503-256-4018
 Fax: 503-256-6298
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Podiatrist

213E00000X 48 Podiatry
Indicates primary specialty

NPI Profile & details for LYNDON G JOHANSEN · (Male)

NPI # 1306820402
Status Active
Credentials DPM (Doctor of Podiatric Medicine)
Entity Individual
Enumeration date 12/01/2005
Last updated 01/02/2013 - About 13 years ago
Sole proprietor 1 Yes
Identifiers
  • OR License # DP00230
  • OR Medicaid 045653
Hospital affiliation(s)
  • ADVENTIST MEDICAL CENTER - (Acute Care)
    10123 SE MARKET STREET
    PORTLAND, OR 97216
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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