Provider Demographics
NPI:1275723827
Name:JAY A JOHNSON MD INC
Entity Type:Organization
Organization Name:JAY A JOHNSON MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSONMD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-464-3801
Mailing Address - Street 1:1667 DOMINICAN WAY STE 230
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1518
Mailing Address - Country:US
Mailing Address - Phone:831-464-3801
Mailing Address - Fax:
Practice Address - Street 1:1667 DOMINICAN WAY STE 230
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1518
Practice Address - Country:US
Practice Address - Phone:831-464-3801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73261207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF36603Medicare UPIN