Provider Demographics
NPI:1639354038
Name:ROBERT L. JOHNSON M.D. INC.
Entity Type:Organization
Organization Name:ROBERT L. JOHNSON M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-681-1102
Mailing Address - Street 1:595 BUCKINGHAM WAY
Mailing Address - Street 2:SUITE 515
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1909
Mailing Address - Country:US
Mailing Address - Phone:415-681-1102
Mailing Address - Fax:
Practice Address - Street 1:595 BUCKINGHAM WAY
Practice Address - Street 2:SUITE 515
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1909
Practice Address - Country:US
Practice Address - Phone:415-681-1102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA19217207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A192170Medicare UPIN
CAZZZ06950ZMedicare UPIN