Provider Demographics
NPI:1285637967
Name:JOHNSON, ERNEST E (MD)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:E
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 1:1111 EXPOSITION BLVD
Mailing Address - Street 2:BLDG 700
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4300
Mailing Address - Country:US
Mailing Address - Phone:916-736-3399
Mailing Address - Fax:916-233-4171
Practice Address - Street 1:1111 EXPOSITION BLVD
Practice Address - Street 2:BLDG 700
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4300
Practice Address - Country:US
Practice Address - Phone:916-736-3399
Practice Address - Fax:916-233-4171
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC19668207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA040003539OtherRR MEDICARE PIN
CA00C196680Medicare PIN
CA040003539OtherRR MEDICARE PIN