Provider Demographics
NPI:1326023011
Name:ROBERT E. BUSH NAVAL HOSPITAL
Entity Type:Organization
Organization Name:ROBERT E. BUSH NAVAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:760-830-2417
Mailing Address - Street 1:58011 HIDDEN GOLD DR
Mailing Address - Street 2:DENNIS W JOHNSON
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-6290
Mailing Address - Country:US
Mailing Address - Phone:760-830-2417
Mailing Address - Fax:
Practice Address - Street 1:MAGTFTC MCAGCC BOX 788250
Practice Address - Street 2:NAVAL HOSPITAL ATTN PROFESSIONAL AFFAIRS
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92278-8250
Practice Address - Country:US
Practice Address - Phone:760-830-2417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74423207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty