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General NPI Number Information
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NPI Number | 1730153826
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Entity Type | Organization
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Legal Business Name | SIERRA NEVADA MEDICAL GROUP
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Dates
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Enumeration Date | 02/15/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1624 LIBRARY LANE SUITE B
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City | MINDEN
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State | NV
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Zip | 89423
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Country | US
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Telephone | 775-782-8186
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Fax | 775-782-4683
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Provider Business Mailing Address
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Address Line | 1077 FOURTH STREET SUITE 12
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150
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Country | US
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Telephone | 530-543-5640
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Fax | 530-541-8723
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID HOWARD JOHNSON
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Credential | MD
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Telephone | 775-782-8186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State | NV
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