Individual
DR. CARL E JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
24 LAS PRADERAS DR, SAN LUIS OBISPO, CA 93401-7410
(805) 544-7832
Mailing address
PO BOX 959, TEMPLETON, CA 93465-0959
(805) 434-1375
(805) 434-1716
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
A33572
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A335720
—
CA
01
—
00A335721
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
07/12/2006
Last updated
07/08/2007
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