Basic Information
| Provider Information | |||||||||
| NPI: | 1619928132 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22769 100TH AVE N | ||||||||
| Address2: | |||||||||
| City: | HAWLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565499629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2189623241 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2101 N. ELM STREET | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 58102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012323241 | ||||||||
| FaxNumber: | 7012393729 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207R00000X | 4457 | ND | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.