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NPI Code Detail

MEDICARE: DAVE R JOHNSON MD

MEDICARE: DAVE R 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
1207R00000XInternal Medicine Physician1584SD

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 : 1821038944
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVE R JOHNSON MD
Provider Business Mailing Address
First Line : 101 E MINNESOTA ST
Second Line : SUITE 260
City : RAPID CITY
State : SD
Zip : 57701-7756
Country : US
Telephone Number : 605-718-7450
Fax Number : 605-718-7465
Provider Business Practice Location Address
First Line : 101 E MINNESOTA ST
Second Line : SUITE 260
City : RAPID CITY
State : SD
Zip : 57701-7756
Country : US
Telephone Number : 605-718-7450
Fax Number : 605-718-7465
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2006
Last Update Date : 11/30/2007

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