Organization
GARY R JOHNSON MD, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY RONALD JOHNSON MD (OWNER/PHYSICAN)
(209) 754-1851
Entity
Organization
Contact information
Practice address
588 W ST CHARLES, SAN ANDREAS, CA 95249
(209) 754-1851
(209) 754-0231
Mailing address
PO BOX 580, SAN ANDREAS, CA 95249-0580
(209) 754-1851
(209) 754-0231
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
G27755
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G277550
—
CA
01
—
1114013513
INDIVIDUAL NPI
CA
Enumeration date
10/20/2006
Last updated
07/10/2019
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