Johansen, Robert Lance

Johansen, Robert Lance is an individual health care provider with primary practice located at 15190 Community Rd Suite 120, Gulfport MS 39503-3484. He recently has only one registered license in Allopathic & Osteopathic Physicians / Adult Reconstructive Orthopaedic Surgery, which is considered as his primary health care specialty. Johansen, Robert Lance can be contacted via phone (228) 328-2400.

Contact Information

Primary practice address
15190 Community Rd Suite 120 Gulfport MS 39503-3484
Phone: (228) 328-2400
Fax: (228) 328-4200
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Adult Reconstructive Orthopaedic Surgery 207XS0114X 14698 Mississippi

Profile Details

NPI number 1861463788
LBN Legal business name Johansen, Robert Lance
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 30th, 2006
Last updated Mar 14th, 2012 - about 14 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1861463788 NPPES
Mississippi Other 5707330001 NSC
Mississippi MEDICAID 00116678 NSC

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