Individual
DR. CLAYTON GARY JOHNSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
1762 N WATERMAN AVE, SAN BERNARDINO, CA 92404-5130
(909) 886-3668
(909) 886-5542
Mailing address
1762 N WATERMAN AVE, SAN BERNARDINO, CA 92404-5130
(909) 886-3668
(909) 886-5542
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
E4834
CA
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PO60139080
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB220721
MEDICARE PTAN
—
Enumeration date
10/05/2009
Last updated
06/20/2022
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