Provider Demographics
NPI:1093049348
Name:JOHNSON, HARRY ALVIN JR (MD FACS)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:ALVIN
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:MD FACS
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Mailing Address - Street 1:4708 TOWNES ROAD
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424
Mailing Address - Country:US
Mailing Address - Phone:952-922-4185
Mailing Address - Fax:952-922-0503
Practice Address - Street 1:4708 TOWNES ROAD
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424
Practice Address - Country:US
Practice Address - Phone:952-922-4185
Practice Address - Fax:952-922-0503
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN16092208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
XZMX27943978OtherBX/BS