Lyndon G Johansen DPM PC

Primary specialty

Podiatric Clinic/CenterTaxonomy code 261QP1100X

Legal business name

LYNDON G JOHANSEN DPM PC

Practice address

12658 SE Stark St
Portland, OR 97233-1058

Phone

(503) 256-4018

Fax

(503) 256-6298

NPI assigned

Feb 7, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lyndon George Johansen, D.P.M.NPI 1306820402

Title

Owner

Phone

(503) 256-4018

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR2 enrollments

Enrollment records 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lyndon G Johansen, DPM

  • Podiatrist
  • Portland, OR
  • NPI 1306820402
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317772800000",
    "number": "1093993453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12658 SE STARK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972331058",
            "telephone_number": "503-256-4018",
            "fax_number": "503-256-6298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12658 SE STARK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972331058",
            "telephone_number": "503-256-4018",
            "fax_number": "503-256-6298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYNDON G JOHANSEN DPM PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-07",
        "last_updated": "2011-10-05",
        "status": "A",
        "authorized_official_last_name": "JOHANSEN",
        "authorized_official_first_name": "LYNDON",
        "authorized_official_middle_name": "GEORGE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-256-4018",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Owen T Lynch, D.C.
• Pamela Jean Lynch, RDH
• Patrick Aaron Lynch, LAC
• Samantha Bailey Lynch, DO
• Susan Liesemer Lynch, LMT
• Lynn Alice Emmons
• Lynn Alvarez, DO, LLC
• Lynn Madsen PC
• Chris Lynn
• Jeremy Scott Lynn, M.D.

• Podiatric Clinic/Center in Portland, OR
• Providers in Portland, OR by specialty
• Podiatric Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.