Healthcare Provider Details

I. General information

NPI: 1205857901
Provider Name (Legal Business Name): TODD CHRISTOPHER JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 12/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 TOWER RD STE 103
DAKOTA DUNES SD
57049-5007
US

IV. Provider business mailing address

573 MONTEREY TRL
DAKOTA DUNES SD
57049-5284
US

V. Phone/Fax

Practice location:
  • Phone: 605-217-7246
  • Fax: 605-217-4878
Mailing address:
  • Phone: 605-422-1130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number4163
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: