Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | A94962 | CA |
N | 207PE0004X | Emergency Medical Services | MD00046336 | WA |
NPI | 1003830316 |
---|---|
Provider Name | Malcolm C Johnson |
First Address | San Francisco, CA 94109 |
Second Address | Walnut Creek, CA 94598-3122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 21/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A949620 | (05) | CA |
I38005 | (02) | WA |