Healthcare Provider Details

I. General information

NPI: 1437149861
Provider Name (Legal Business Name): DAVID F JOHNSON JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 N STATE ST
OSMOND NE
68765-5722
US

IV. Provider business mailing address

PO BOX 459
OSMOND NE
68765-0459
US

V. Phone/Fax

Practice location:
  • Phone: 402-748-3366
  • Fax: 402-748-3367
Mailing address:
  • Phone: 402-748-3366
  • Fax: 402-748-3367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11373
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: