=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487666814
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TODD E JOHNSON DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2006
-----------------------------------------------------
Last Update Date | 02/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5000 N 26TH ST
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68521-4749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-435-5300
-----------------------------------------------------
Fax | 402-435-5511
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8055 O ST STE 300
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68510-2580
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-421-0896
-----------------------------------------------------
Fax | 402-421-0945
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 352
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------