Healthcare Provider Details

I. General information

NPI: 1669578357
Provider Name (Legal Business Name): MARK E JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 5TH ST
MARYSVILLE CA
95901-5646
US

IV. Provider business mailing address

1114 YUBA ST SUITE 144
MARYSVILLE CA
95901-4838
US

V. Phone/Fax

Practice location:
  • Phone: 530-749-3242
  • Fax: 530-749-3248
Mailing address:
  • Phone: 530-741-6245
  • Fax: 530-741-9274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD00044906
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: