05D0862377 CLIA NUMBER - GARY R JOHNSON MD

Laboratory Demographics

CLIA Number: 05D0862377

Facility Name: GARY R JOHNSON MD

Facility Address:
588 W ST CHARLES ST
SAN ANDREAS, CA
ZIP 95249
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Facility Phone Number: 209 754-1851

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1114013513

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	05D0862377
LAB Type	Physician Office
Facility Name	GARY R JOHNSON MD
Street	588 W ST CHARLES ST
City	SAN ANDREAS
State	CA
ZIP	95249
Phone	209 754-1851
CertificateType	3
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	PPMP

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This page was last updated on: 4/23/2024