Provider Demographics
NPI:1912017146
Name:JOHNSON, THOMAS ROBERT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ROBERT
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DANIEL BURNHAM CT
Mailing Address - Street 2:#365C
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5455
Mailing Address - Country:US
Mailing Address - Phone:415-409-7364
Mailing Address - Fax:415-409-0741
Practice Address - Street 1:1 DANIEL BURNHAM CT
Practice Address - Street 2:#365C
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5455
Practice Address - Country:US
Practice Address - Phone:415-409-7364
Practice Address - Fax:415-409-0741
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11277363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant