Provider Demographics
NPI:1538298575
Name:RONALD JOHANSON, THOMAS WILSON, JAMES MACLAREN PTRS
Entity Type:Organization
Organization Name:RONALD JOHANSON, THOMAS WILSON, JAMES MACLAREN PTRS
Other - Org Name:FAMILY MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:C
Authorized Official - Last Name:KAHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-668-4101
Mailing Address - Street 1:911 E TUOLUMNE RD
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-1543
Mailing Address - Country:US
Mailing Address - Phone:209-668-4101
Mailing Address - Fax:209-668-3758
Practice Address - Street 1:911 E TUOLUMNE RD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-1543
Practice Address - Country:US
Practice Address - Phone:209-668-4101
Practice Address - Fax:209-668-3758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ86221ZMedicare ID - Type Unspecified