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General NPI Number Information
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NPI Number | 1790876688
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Entity Type | Individual
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Provider Name | PAUL B JOHNSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4080 W BROADWAY AVE SUITE 200
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City | ROBBINSDALE
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State | MN
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Zip | 55422-5604
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Country | US
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Telephone | 763-520-5551
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Fax | 763-520-1734
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Provider Business Mailing Address
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Address Line | 4080 W BROADWAY AVE SUITE 200
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City | ROBBINSDALE
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State | MN
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Zip | 55422-5604
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Country | US
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Telephone | 763-520-5551
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Fax | 763-520-1734
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 17347
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License Number State | MN
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