Provider Demographics
NPI:1457423469
Name:JOHNSON, WARREN MARION (DPM)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:MARION
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3775 BEACON AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1466
Mailing Address - Country:US
Mailing Address - Phone:510-794-6633
Mailing Address - Fax:510-794-6637
Practice Address - Street 1:3775 BEACON AVE
Practice Address - Street 2:STE 120
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1466
Practice Address - Country:US
Practice Address - Phone:510-794-6633
Practice Address - Fax:510-794-6637
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2018-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1285213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T10871Medicare UPIN
000E12850Medicare ID - Type Unspecified