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NPI Code Detail

MEDICARE: PETER DAVID JOHNSON MD

MEDICARE: PETER DAVID JOHNSON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation Physician4108SD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588660393
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER DAVID JOHNSON MD
Provider Business Mailing Address
First Line : PO BOX 5074
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57117-5074
Country : US
Telephone Number : 605-328-9556
Fax Number : 605-328-9501
Provider Business Practice Location Address
First Line : 1210 W 18TH ST
Second Line : STE 100
City : SIOUX FALLS
State : SD
Zip : 57104-9890
Country : US
Telephone Number : 605-312-8500
Fax Number : 605-312-8501
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2005
Last Update Date : 03/25/2022

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Directions to “ PETER DAVID JOHNSON MD” Practice Location

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