Provider Demographics
NPI:1255387072
Name:JOHNSON, SHARON ROSE (MD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:ROSE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HOSPITAL RD
Mailing Address - Street 2:MEDICAL STAFF/TUOLUMNE GENERAL HOSPITAL
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5227
Mailing Address - Country:US
Mailing Address - Phone:209-533-7146
Mailing Address - Fax:
Practice Address - Street 1:101 HOSPITAL RD
Practice Address - Street 2:MEDICAL STAFF/TUOLUMNE GENERAL HOSPITAL
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5227
Practice Address - Country:US
Practice Address - Phone:209-533-7146
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49491207L00000X
AZ27912207L00000X
IN01052694A207L00000X
MDD58711207L00000X
MT9634207L00000X
NE21671207L00000X
NV6618207L00000X
NM99-59207L00000X
PAMD045212E207L00000X
SD5025207L00000X
WV19466207L00000X
WI43294207L00000X
TN207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E91671Medicare UPIN