Provider Demographics
NPI:1093758633
Name:JOHNSON, GARY ROY (DVM, DO)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ROY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DVM, DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46-401 HOLOKAA ST
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-4217
Mailing Address - Country:US
Mailing Address - Phone:808-235-9007
Mailing Address - Fax:808-235-9007
Practice Address - Street 1:46-401 HOLOKAA ST
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-4217
Practice Address - Country:US
Practice Address - Phone:808-259-7948
Practice Address - Fax:808-259-7447
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine