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General NPI Number Information
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NPI Number | 1669578357
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Entity Type | Individual
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Provider Name | MARK E JOHNSON MD
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Gender | Male
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 07/02/2015
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Provider Practice Location Address
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Address Line | 724 5TH ST
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City | MARYSVILLE
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State | CA
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Zip | 95901-5646
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Country | US
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Telephone | 530-749-3242
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Fax | 530-749-3248
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Provider Business Mailing Address
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Address Line | 1114 YUBA ST SUITE 144
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City | MARYSVILLE
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State | CA
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Zip | 95901-4838
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Country | US
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Telephone | 530-741-6245
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Fax | 530-741-9274
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD00044906
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License Number State | WA
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