Healthcare Provider Details

I. General information

NPI: 1285637967
Provider Name (Legal Business Name): ERNEST E JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 08/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 EXPOSITION BLVD BLDG 700
SACRAMENTO CA
95815-4300
US

IV. Provider business mailing address

1111 EXPOSITION BLVD BLDG 700
SACRAMENTO CA
95815-4300
US

V. Phone/Fax

Practice location:
  • Phone: 916-736-3399
  • Fax: 916-233-4171
Mailing address:
  • Phone: 916-736-3399
  • Fax: 916-233-4171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberC19668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: