Delta Podiatry Group, Inc.

Primary specialty

PodiatristTaxonomy code 213E00000X

License

E1406 Issued in CA

Legal business name

DELTA PODIATRY GROUP, INC.

Practice address

1205 N Hunter St
Stockton, CA 95202-1409

Phone

(209) 464-7367

Fax

(209) 464-1801

NPI assigned

Jan 14, 2007

Last updated

Apr 2, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lynn Robert Johnson, DPMNPI 1619949187

Title

President

Phone

(209) 464-7367

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lynn Robert Johnson, DPM

  • Podiatrist
  • Stockton, CA
  • NPI 1619949187
  Authorized official Same address or phone
• Weldon R Hess, DPM

  • Foot Surgery Podiatrist
  • Stockton, CA
  • NPI 1427022995
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238630400000",
    "number": "1023169471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 N HUNTER ST",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952021409",
            "telephone_number": "209-464-7367",
            "fax_number": "209-464-1801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 N HUNTER ST",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952021409",
            "telephone_number": "209-464-7367",
            "fax_number": "209-464-1801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA PODIATRY GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-14",
        "last_updated": "2009-04-02",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "LYNN",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-464-7367",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "CA",
            "license": "E1406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "E1406",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ73253Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Podiatrist in Stockton, CA
• Providers in Stockton, CA by specialty
• Podiatrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.