Provider Demographics
NPI:1972512432
Name:JOHNSON, DENNIS ELWOOD (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:ELWOOD
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 1:1610 S COURT ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-4946
Mailing Address - Country:US
Mailing Address - Phone:559-625-8898
Mailing Address - Fax:559-625-8010
Practice Address - Street 1:1610 S COURT ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4946
Practice Address - Country:US
Practice Address - Phone:559-625-8898
Practice Address - Fax:559-625-8010
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G603580174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G603580Medicare PIN
CAA53583Medicare UPIN