Provider Demographics
NPI:1497704506
Name:JOHNSON, NORMAN ERIC (MD)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:ERIC
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:PO BOX 6865
Mailing Address - Street 2:
Mailing Address - City:BIG BEAR LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92315-6865
Mailing Address - Country:US
Mailing Address - Phone:909-878-3696
Mailing Address - Fax:909-878-3697
Practice Address - Street 1:41949 BIG BEAR BLVD
Practice Address - Street 2:
Practice Address - City:BIG BEAR LAKE
Practice Address - State:CA
Practice Address - Zip Code:92315-6865
Practice Address - Country:US
Practice Address - Phone:909-878-3696
Practice Address - Fax:909-878-3697
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC37654207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C376546Medicare PIN
CAA36705Medicare UPIN