Healthcare Provider Details

I. General information

NPI: 1053341594
Provider Name (Legal Business Name): DANIEL R JOHNSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3745 GEIST ROAD
FAIRBANKS AK
99709-3554
US

IV. Provider business mailing address

315 ILLINOIS STREET
FAIRBANKS AK
99701-2910
US

V. Phone/Fax

Practice location:
  • Phone: 907-456-3338
  • Fax:
Mailing address:
  • Phone: 907-456-7767
  • Fax: 907-456-8050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5762
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: