Provider Demographics
NPI:1861421372
Name:JOHNSON, MARK YARWOOD (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:YARWOOD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:65 CATSPAW CPE
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-3221
Mailing Address - Country:US
Mailing Address - Phone:619-585-0313
Mailing Address - Fax:619-585-0037
Practice Address - Street 1:480 4TH AVE
Practice Address - Street 2:SUITE 506
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4410
Practice Address - Country:US
Practice Address - Phone:619-585-0313
Practice Address - Fax:619-585-0037
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG28163207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43635OtherUPIN
CA100001724OtherMEDICARE RAILROAD
CA00G281630Medicaid
CA100001724OtherMEDICARE RAILROAD