Provider Demographics
NPI:1245201318
Name:JOHNSON, DOYLE EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:DOYLE
Middle Name:EUGENE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11648 CAMINITO CORRIENTE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4540
Mailing Address - Country:US
Mailing Address - Phone:619-994-3633
Mailing Address - Fax:
Practice Address - Street 1:BRANCH MEDICAL CLINIC 2450 CRAVEN ST
Practice Address - Street 2:MEDICAL HOME PORT
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92136-5599
Practice Address - Country:US
Practice Address - Phone:619-556-8101
Practice Address - Fax:619-556-9419
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2013-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO41142207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine