Provider Demographics
NPI:1598942781
Name:JOHNSON, ROBERT RYN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:RYN
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 1:100 CASA ST STE C
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-8804
Mailing Address - Country:US
Mailing Address - Phone:805-541-1932
Mailing Address - Fax:805-541-1653
Practice Address - Street 1:100 CASA ST STE C
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-8804
Practice Address - Country:US
Practice Address - Phone:805-541-1932
Practice Address - Fax:805-541-1653
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1210322085R0203X, 2085R0203X
KYIP11022085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1598942781Medicaid