Provider Demographics
NPI:1457305641
Name:JOHANSSON, KARL HARVEY (MD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:HARVEY
Last Name:JOHANSSON
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:PO BOX 5040
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966
Mailing Address - Country:US
Mailing Address - Phone:530-532-8584
Mailing Address - Fax:530-532-8433
Practice Address - Street 1:2809 OLIVE HWY STE 320
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-6135
Practice Address - Country:US
Practice Address - Phone:530-532-8181
Practice Address - Fax:530-538-3083
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23456207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A234560Medicaid
P0013034OtherRAILROAD MEDICARE
CA00A234560Medicaid
CA00A234561Medicare ID - Type Unspecified