Healthcare Provider Details

I. General information

NPI: 1861620908
Provider Name (Legal Business Name): JOSEPH GERARD JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2009
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST SUITE 2700
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

4925 9TH AVENUE
SACRAMENTO CA
95820
US

V. Phone/Fax

Practice location:
  • Phone: 402-990-9107
  • Fax:
Mailing address:
  • Phone: 402-990-9107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number27371
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA122860
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number6092
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: