| Doctor Name: | DR. GARY RONALD JOHNSON |
| NPI Number: | 1114013513 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | G27755 |
| Business Practice Address: | 588 W. St.charles Street San Andreas, CA - 95249 |
| Business Phone Number: | 2097541851 |
| Business Fax Number: | 2097540231 |
| Mailing Address: | Po Box 580, SAN ANDREAS |
| State: | CA |
| Postal Code: | 95249 |
| Phone Number: | 2097541851 |
| Fax Number: | 2097540231 |
| NPI Enumeration Date: | 10/04/2006 |
| NPI Last Update Date: | 03/07/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | G27755 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |