Organization
NEIL G. JOHNSON, M.D. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NEIL G JOHNSON M.D. (PRESIDENT)
(909) 881-6427
Entity
Organization
Contact information
Practice address
18300 US HIGHWAY 18, C/O ST. MARY MEDICAL CENTER, APPLE VALLEY, CA 92307-2206
(909) 881-6427
(909) 887-8708
Mailing address
PO BOX 9160, SAN BERNARDINO, CA 92427-0160
(909) 881-6427
(909) 887-8708
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
G20232
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0079600
—
CA
01
—
ZZZ13874Z
NHIC/NCA
CA
01
—
ZZZ54436Z
BLUE SHIELD PROVIDER #
CA
Enumeration date
05/24/2007
Last updated
03/05/2008
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