Healthcare Provider Details

I. General information

NPI: 1366734998
Provider Name (Legal Business Name): JEFFREY DAVID JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W PUEBLO ST
SANTA BARBARA CA
93105-4353
US

IV. Provider business mailing address

PO BOX 689
SANTA BARBARA CA
93102-0689
US

V. Phone/Fax

Practice location:
  • Phone: 805-879-8160
  • Fax: 805-225-6231
Mailing address:
  • Phone: 805-879-8160
  • Fax: 805-225-6231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number57583
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC172584
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: