Healthcare Provider Details

I. General information

NPI: 1356399455
Provider Name (Legal Business Name): ROBERT A JOHNSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 E WASHINGTON ROW
SANDUSKY OH
44870-2609
US

IV. Provider business mailing address

167 E WASHINGTON ROW
SANDUSKY OH
44870-2609
US

V. Phone/Fax

Practice location:
  • Phone: 419-217-3329
  • Fax: 567-214-4101
Mailing address:
  • Phone: 419-217-3329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34.0066768
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34.006768
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200400526
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: