Johanson, Gary Andrew

Johanson, Gary Andrew is an sole proprietor health care provider with primary practice located at 500 Doyle Park Dr Suite G04, Santa Rosa CA 95405-4558. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Hospice and Palliative Medicine. Allopathic & Osteopathic Physicians / Hospice and Palliative Medicine is his primary health care specialty. Johanson, Gary Andrew can be contacted via phone (707) 573-8984.

Contact Information

Primary practice address
500 Doyle Park Dr Suite G04 Santa Rosa CA 95405-4558
Phone: (707) 573-8984
Fax: (707) 573-0982
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X G32438 California
Allopathic & Osteopathic Physicians / Hospice and Palliative Medicine 207QH0002X G32438 California

Profile Details

NPI number 1215043229
LBN Legal business name Johanson, Gary Andrew
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 22nd, 2006
Last updated Nov 3rd, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215043229 NPPES
California Other 680479679 TAX ID
California Other 33-0185031 TAX ID

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