Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 41487 | MN |
NPI | 1003827908 |
---|---|
Provider Name | Paul L Johnson |
First Address | Mankato, MN 56001-7893 |
Second Address | Mankato, MN 56001-4752 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 20/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05F00JO | BLUE CROSS BLUE SHIELD (01) | MN |
123607 | UCARE (01) | |
2000870 | MEDICA (01) | |
967551028364 | PREFERRED ONE (01) | |
F51268 | (02) | |
HP57496 | HEALTH PARTNERS (01) |