Provider Demographics
NPI:1538162201
Name:JOHNSON, MARTIN LLOYD (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:LLOYD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4547
Mailing Address - Country:US
Mailing Address - Phone:602-618-8993
Mailing Address - Fax:
Practice Address - Street 1:2833 BABCOCK RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5390
Practice Address - Country:US
Practice Address - Phone:210-705-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2024-06-11
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
AZ11854208200000X
CA37362208200000X
TXE4435208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD44083Medicare UPIN