Basic Information
| Provider Information | |||||||||
| NPI: | 1457305641 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHANSSON | ||||||||
| FirstName: | KARL | ||||||||
| MiddleName: | HARVEY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5040 | ||||||||
| Address2: | |||||||||
| City: | OROVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305328584 | ||||||||
| FaxNumber: | 5305328433 | ||||||||
| Practice Location | |||||||||
| Address1: | 2809 OLIVE HWY STE 320 | ||||||||
| Address2: | |||||||||
| City: | OROVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959666135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305328181 | ||||||||
| FaxNumber: | 5305383083 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 06/06/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | A23456 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 00A234560 | 05 | CA | MEDICAID | P0013034 | 01 | RAILROAD MEDICARE | OTHER |