Healthcare Provider Details

I. General information

NPI: 1477682953
Provider Name (Legal Business Name): CRAIG E. JOHNSON MD, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2299 MOWRY AVE SUITE 2A
FREMONT CA
94538-1621
US

IV. Provider business mailing address

2299 MOWRY AVE SUITE 2A
FREMONT CA
94538-1621
US

V. Phone/Fax

Practice location:
  • Phone: 510-796-3498
  • Fax: 510-794-4109
Mailing address:
  • Phone: 510-796-3498
  • Fax: 510-794-4109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG86787
License Number StateCA

VIII. Authorized Official

Name: DR. CRAIG E JOHNSON
Title or Position: PRESIDENT
Credential: MD
Phone: 510-796-3498