Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 55662 | MN |
NPI | 1225220494 |
---|---|
Provider Name | Dr. Todd Christopher Johnson |
First Address | Saint Paul, MN 55101-2502 |
Second Address | Saint Paul, MN 55101-2502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2007 |
Last Update Date | 13/11/2012 |