Provider Demographics
NPI:1598030066
Name:JOHNSON, LEONARD MORRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:MORRIS
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 1:568 MONARCH RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2956
Mailing Address - Country:US
Mailing Address - Phone:925-324-4981
Mailing Address - Fax:
Practice Address - Street 1:568 MONARCH RIDGE DR
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-2956
Practice Address - Country:US
Practice Address - Phone:925-324-4981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-17
Last Update Date:2012-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25717174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist