Provider Demographics
NPI:1134111339
Name:JOHNSON, ARLAN TIMOTHY (MD PHD)
Entity Type:Individual
Prefix:
First Name:ARLAN
Middle Name:TIMOTHY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:A
Other - Middle Name:TIM
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD PHD
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-8118
Mailing Address - Fax:319-353-7699
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-8118
Practice Address - Fax:319-353-7699
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26622207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0073023Medicaid
IA04098OtherWELLMARK BCBS
IA0073023Medicaid
IA04098Medicare PIN