MEDICARE: KEITH A JOHNSON MD

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	G87266	CA

General Provider Information

NPI Number	:	1568449494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH A JOHNSON MD

Provider Business Mailing Address
First Line	:	1450 TREAT BLVD
Second Line	:	STE 300
City	:	WALNUT CREEK
State	:	CA
Zip	:	94597-2168
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 TREAT BLVD
Second Line	:	STE 160
City	:	WALNUT CREEK
State	:	CA
Zip	:	94597-2168
Country	:	US
Telephone Number	:	925-296-9000
Fax Number	:	925-296-9071

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	12/08/2016

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