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General NPI Number Information
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NPI Number | 1679559975
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Entity Type | Individual
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Provider Name | MAX RAY JOHNSON MD
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Gender | Male
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Dates
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Enumeration Date | 12/19/2005
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 4450 31ST AVE S STE 200
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City | FARGO
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State | ND
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Zip | 58104-4556
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Country | US
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Telephone | 701-293-9829
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Fax | 701-293-0111
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Provider Business Mailing Address
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Address Line | 4450 31ST AVE S STE 200
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City | FARGO
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State | ND
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Zip | 58104-4556
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Country | US
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Telephone | 701-293-9829
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Fax | 701-293-0111
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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 | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | 5573
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License Number State | ND
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