Provider Demographics
NPI:1902855067
Name:JOHNSON, MARY ANNE GAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY ANNE
Middle Name:GAIL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4150 CLEMENT ST
Mailing Address - Street 2:11-CP
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-1545
Mailing Address - Country:US
Mailing Address - Phone:415-221-4810
Mailing Address - Fax:415-750-2185
Practice Address - Street 1:4150 CLEMENT ST
Practice Address - Street 2:11-CP
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-1545
Practice Address - Country:US
Practice Address - Phone:415-221-4810
Practice Address - Fax:415-750-2185
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
CAG34015207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine