Provider Demographics
NPI:1164484424
Name:JOHNSON, DAVID B (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 AVENUE B
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4617
Mailing Address - Country:US
Mailing Address - Phone:308-630-2101
Mailing Address - Fax:
Practice Address - Street 1:3911 AVENUE B
Practice Address - Street 2:SUITE 1100
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4617
Practice Address - Country:US
Practice Address - Phone:308-630-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0422461207RH0003X
NE27303207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1286700002OtherDMERC REGION 1
KS1286700007OtherDMERC REGION 1
KS1286700005OtherDMERC REGION 1
KS1286700003OtherDMERC REGION 1
KS1286700013OtherDMERC REGION 1
KS1286700004OtherDMERC REGION 1
KS12867010010OtherDMERC REGION 1
KS1286700009OtherDMERC REGION 1
KS1286700015OtherDMERC REGION 1
KS1286700011OtherDMERC REGION 1
KS100113230DMedicaid
KS1286700006OtherDMERC REGION 1
KS1286700008OtherDMERC REGION 1
KS1286700012OtherDMERC REGION 1
KS1286700008OtherDMERC REGION 1
KS1286700013OtherDMERC REGION 1