MEDICARE: DR. RICHARD G JOHNSON JR. M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	G45973	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083691182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD G JOHNSON JR. M.D

Provider Business Mailing Address
First Line	:	415 W CARROLL AVE
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91741-4208
Country	:	US
Telephone Number	:	626-914-5219
Fax Number	:	626-914-7846

Provider Business Practice Location Address
First Line	:	415 W CARROLL AVE
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91741-4208
Country	:	US
Telephone Number	:	626-914-5219
Fax Number	:	626-914-7846

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	03/25/2011

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