Healthcare Provider Details

I. General information

NPI: 1235312257
Provider Name (Legal Business Name): JAMES F JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9847 BLOOMFIELD DR
OMAHA NE
68114-2117
US

IV. Provider business mailing address

9847 BLOOMFIELD DR
OMAHA NE
68114-2117
US

V. Phone/Fax

Practice location:
  • Phone: 402-397-1148
  • Fax:
Mailing address:
  • Phone: 402-397-1148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number10857
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: