Provider Demographics
NPI:1770562712
Name:JOHNSON, CHRISTOPHER WARREN (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:WARREN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3599 SUELDO STREET
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7389
Mailing Address - Country:US
Mailing Address - Phone:805-786-2500
Mailing Address - Fax:805-781-0823
Practice Address - Street 1:525 EAST PLAZA DRIVE
Practice Address - Street 2:SUITE 304
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6955
Practice Address - Country:US
Practice Address - Phone:805-349-7133
Practice Address - Fax:805-349-7137
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2012-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY220068208800000X
CAA77635208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY35R001Medicare ID - Type Unspecified
NYI09951Medicare UPIN