Individual
GARY ANDREW JOHANSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 DOYLE PARK DR, SUITE G04, SANTA ROSA, CA 95405-4558
(707) 573-8984
(707) 573-0982
Mailing address
500 DOYLE PARK DR, SUITE G04, SANTA ROSA, CA 95405-4558
(707) 573-8984
(707) 573-0982
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
G32438
CA
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
G32438
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33-0185031
TAX ID# AS OF 9/1/2010
CA
01
—
680479679
TAX ID
CA
Enumeration date
08/22/2006
Last updated
11/03/2021
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