Doctor Name: | DOUGLAS ALLAN JOHNSON |
NPI Number: | 1841223708 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 22875 |
Business Practice Address: | 2501 Keenan Dr International Falls, MN - 566492181 |
Business Phone Number: | 2182939431 |
Business Fax Number: | 2182856875 |
Mailing Address: | 2501 Keenan Dr, INTERNATIONAL FALLS |
State: | MN |
Postal Code: | 566492181 |
Phone Number: | 2182939431 |
Fax Number: | 2182856875 |
NPI Enumeration Date: | 07/07/2006 |
NPI Last Update Date: | 05/20/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 22875 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |