Healthcare Provider Details

I. General information

NPI: 1659489227
Provider Name (Legal Business Name): ROBERT G JOHANNESEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 12/07/2025
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 4TH ST SW STE 340
MASON CITY IA
50401-2856
US

IV. Provider business mailing address

621 S ILLINOIS AVE SUITE 103
MASON CITY IA
50401-5489
US

V. Phone/Fax

Practice location:
  • Phone: 641-428-7766
  • Fax: 641-428-7788
Mailing address:
  • Phone: 641-494-3041
  • Fax: 641-494-3059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21463
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: