Basic Information
| Provider Information | |||||||||
| NPI: | 1558330134 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | RODGER | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1580 BEAM AVE | ||||||||
| Address2: | |||||||||
| City: | MAPLEWOOD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551091127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517797978 | ||||||||
| FaxNumber: | 6517797656 | ||||||||
| Practice Location | |||||||||
| Address1: | 1580 BEAM AVE | ||||||||
| Address2: | |||||||||
| City: | MAPLEWOOD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551091127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517797978 | ||||||||
| FaxNumber: | 6517797656 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 18580 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 23257 | 01 | MN | AMERICA'S PPO | OTHER | 3600784 | 01 | MN | MEDICA | OTHER | 105481 | 01 | MN | UCARE MN | OTHER | 61275900 | 05 | WI | MEDICAID | HP13626 | 01 | MN | HEALTHPARTNERS | OTHER | 0010102 | 01 | MN | PREFERREDONE | OTHER | 8T422JO | 01 | MN | BLUE CROSS BLUE SHIELD MN | OTHER |