Healthcare Provider Details

I. General information

NPI: 1548272446
Provider Name (Legal Business Name): R BRUCE JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 HEALTH CENTER DR
SAN DIEGO CA
92123-2762
US

IV. Provider business mailing address

2929 HEALTH CENTER DR
SAN DIEGO CA
92123-2762
US

V. Phone/Fax

Practice location:
  • Phone: 858-939-6531
  • Fax: 858-874-2351
Mailing address:
  • Phone: 858-939-6531
  • Fax: 858-874-2351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberC28502
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: