Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | A79547 | CA |
NPI | 1033251681 |
---|---|
Provider Name | Marc Douglas Johnson |
First Address | Pacific Grove, CA 93950 |
Second Address | Salinas, CA 93907-2370 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 16/05/2020 |