MEDICARE: DR. MAXWELL BATES JOHNSON MD, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	A159221	CA

General Provider Information

NPI Number	:	1568903888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAXWELL BATES JOHNSON MD, MS

Provider Business Mailing Address
First Line	:	867 MONTEREY RD
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-3157
Country	:	US
Telephone Number	:	323-202-5765
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 SAN PABLO ST STE 415
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-5403
Country	:	US
Telephone Number	:	323-442-7903
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2017
Last Update Date	:	07/21/2022

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