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General NPI Number Information
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NPI Number | 1063550622
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Entity Type | Organization
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Legal Business Name | ASSOCIATED PODIATRY GROUP
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 01/18/2008
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Provider Practice Location Address
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Address Line | 730 16TH ST
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City | MODESTO
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State | CA
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Zip | 95354-2519
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Country | US
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Telephone | 209-529-9450
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Fax | 209-529-3439
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Provider Business Mailing Address
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Address Line | 730 16TH ST
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City | MODESTO
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State | CA
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Zip | 95354-2519
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Country | US
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Telephone | 209-529-9450
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Fax | 209-529-3439
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Authorized Official
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Title or Position | OWNER
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Name | DR. LYNN ROBERT JOHNSON
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Credential | DPM
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Telephone | 209-529-9450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E1406
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License Number State | CA
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