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General NPI Number Information
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NPI Number | 1265515977
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Entity Type | Individual
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Provider Name | BARRY DUANE JOHNSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 06/19/2015
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Provider Practice Location Address
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Address Line | 1100 S CARPENTER AVE
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City | KINGSFORD
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State | MI
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Zip | 49802-5518
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Country | US
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Telephone | 906-776-5480
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Fax | 906-228-0203
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Provider Business Mailing Address
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Address Line | PO BOX 549
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City | IRON MOUNTAIN
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State | MI
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Zip | 49801-0549
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Country | US
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Telephone | 906-774-1313
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Fax | 906-776-5639
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 4301042058
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 4301042058
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License Number State | MI
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