MEDICARE: NEIL GRANT 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	207T00000X	Neurological Surgery Physician	G20232	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	:	1740274380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEIL GRANT JOHNSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 9160
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92427-0160
Country	:	US
Telephone Number	:	909-881-6427
Fax Number	:	909-887-8708

Provider Business Practice Location Address
First Line	:	18300 US HIGHWAY 18
Second Line	:	ST. MARY MEDICAL CENTER
City	:	APPLE VALLEY
State	:	CA
Zip	:	92307-2206
Country	:	US
Telephone Number	:	909-881-6427
Fax Number	:	909-880-8708

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	03/05/2008

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