MEDICARE: DOYLE EUGENE JOHNSON 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	207Q00000X	Family Medicine Physician	CO41142	CO

General Provider Information

NPI Number	:	1245201318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOYLE EUGENE JOHNSON M.D.

Provider Business Mailing Address
First Line	:	11648 CAMINITO CORRIENTE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-4540
Country	:	US
Telephone Number	:	619-994-3633
Fax Number	:

Provider Business Practice Location Address
First Line	:	BRANCH MEDICAL CLINIC 2450 CRAVEN ST
Second Line	:	MEDICAL HOME PORT
City	:	SAN DIEGO
State	:	CA
Zip	:	92136-5599
Country	:	US
Telephone Number	:	619-556-8101
Fax Number	:	619-556-9419

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

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	03/30/2013

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