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General NPI Number Information
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NPI Number | 1578588232
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Entity Type | Individual
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Provider Name | ROBERT D. JOHNSON PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 05/07/2023
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Provider Practice Location Address
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Address Line | 2545 W. HAMMER LN.
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City | STOCKTON
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State | CA
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Zip | 95209-7597
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Country | US
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Telephone | 209-948-1641
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 255228
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City | SACRAMENTO
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State | CA
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Zip | 95865
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA60674
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License Number State | CA
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