Provider Demographics
NPI:1932215092
Name:JOHNSON, NOAH COMPTON (MD)
Entity Type:Individual
Prefix:DR
First Name:NOAH
Middle Name:COMPTON
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 1:10158 BUENA VISTA AVENUE
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071
Mailing Address - Country:US
Mailing Address - Phone:619-562-1140
Mailing Address - Fax:619-562-5362
Practice Address - Street 1:10158 BUENA VISTA AVENUE
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071
Practice Address - Country:US
Practice Address - Phone:619-562-1140
Practice Address - Fax:619-562-5362
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79548207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA79548AMedicare PIN
H85302Medicare UPIN