Provider Demographics
NPI:1780632299
Name:JOHNSON, FRANKLIN MARTIN JR (DO)
Entity Type:Individual
Prefix:DR
First Name:FRANKLIN
Middle Name:MARTIN
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1310 SAN BERNARDINO RD
Mailing Address - Street 2:STE 201
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4979
Mailing Address - Country:US
Mailing Address - Phone:909-355-7855
Mailing Address - Fax:909-355-7856
Practice Address - Street 1:1310 SAN BERNARDINO RD
Practice Address - Street 2:STE 201
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4979
Practice Address - Country:US
Practice Address - Phone:909-355-7855
Practice Address - Fax:909-355-7856
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7957174400000X, 207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI15896Medicare UPIN