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General NPI Number Information
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NPI Number | 1639147697
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Entity Type | Individual
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Provider Name | WAYNE CARLETON JOHNSON IDC
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Gender | Male
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | NAVAL HOSPITAL BOX 788250
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City | TWENTYNINE PALMS
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State | CA
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Zip | 92278-8250
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Country | US
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Telephone | 760-830-2677
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Fax | 760-830-2601
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Provider Business Mailing Address
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Address Line | 3848B WESTSIDE RD
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City | TWENTYNINE PALMS
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State | CA
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Zip | 92277-9407
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Country | US
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Telephone | 760-368-2149
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Fax | 760-830-2601
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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 | 1710I1002X
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Taxonomy Name | Independent Duty Corpsman
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License Number |
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License Number State |
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