Individual
DR. FREDERICK L JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
987 PARALLEL DR, LAKEPORT, CA 95453-5702
(707) 263-7428
(707) 263-7425
Mailing address
987 PARALLEL DR, LAKEPORT, CA 95453-5702
(707) 263-7428
(707) 263-7425
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A556180
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A556180
BLUE SHIELD
CA
05
—
00A556180
—
CA
01
—
A55618
LICENSE
CA
01
—
CN2480
RAILROAD MEDICARE
—
Enumeration date
01/03/2007
Last updated
05/20/2019
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