Basic Information
| Provider Information | |||||||||
| NPI: | 1477597516 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 N 9TH ST | ||||||||
| Address2: | |||||||||
| City: | BISMARCK | ||||||||
| State: | ND | ||||||||
| PostalCode: | 585014507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7015306000 | ||||||||
| FaxNumber: | 7015306000 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 N 9TH ST | ||||||||
| Address2: | |||||||||
| City: | BISMARCK | ||||||||
| State: | ND | ||||||||
| PostalCode: | 585014507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7015306000 | ||||||||
| FaxNumber: | 7015306000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 06/24/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 7979 | ND | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 10567 | 05 | ND | MEDICAID | 020038507 | 01 | ND | MEDICARE RAILROAD | OTHER |