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Organization

DELTA PODIATRY GROUP, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LYNN ROBERT JOHNSON DPM (PRESIDENT)
(209) 464-7367
Entity
Organization

Contact information

Practice address
1205 N HUNTER ST, STOCKTON, CA 95202-1409
(209) 464-7367
(209) 464-1801
Mailing address
1205 N HUNTER ST, STOCKTON, CA 95202-1409
(209) 464-7367
(209) 464-1801

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
E1406
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
E1406
LICENSE NUMBER
CA
05
ZZZ73253Z
CA
Enumeration date
01/14/2007
Last updated
04/02/2009
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