Individual
DR. MEADE BEASLEY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1520 SAN PABLO ST, STE. 1600, LOS ANGELES, CA 90033-5310
(323) 442-7450
Mailing address
PO BOX 31399, LOS ANGELES, CA 90031-0399
(626) 457-5842
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
G45908
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G459080
BLUE SHIELD
CA
05
—
00G459080
—
CA
01
—
00G459080G56
CAL OPTIMA
CA
01
—
300031908
RAIL ROAD
CA
Enumeration date
06/15/2006
Last updated
11/30/2007
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