Organization Name: | BEAR MOUNTAIN MEDICINE INC |
NPI Number: | 1538220645 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | NORMAN ERIC JOHNSON (MANAGING PHYSICIAN) |
Mailing Address: | 41949 Big Bear Blvd Big Bear Lake |
State: | CA US |
Postal Code: | 923156865 |
Phone Number: | 9098783696 |
Fax Number: | 9098783697 |
NPI Enumeration Date: | 12/12/2006 |
NPI Last Update Date: | 06/03/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |