Healthcare Provider Details

I. General information

NPI: 1578838298
Provider Name (Legal Business Name): JENNIFER ELLEN JOHNSON BYER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 DOYLE PARK DR SUITE G06
SANTA ROSA CA
95405-4558
US

IV. Provider business mailing address

500 DOYLE PARK DR SUITE G06
SANTA ROSA CA
95405-4558
US

V. Phone/Fax

Practice location:
  • Phone: 707-303-1719
  • Fax:
Mailing address:
  • Phone: 707-303-1719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberA119671
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: