Provider Demographics
NPI:1225220494
Name:JOHNSON, TODD CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:CHRISTOPHER
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:640 JACKSON ST
Mailing Address - Street 2:MAIL STOP: 11503L
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2502
Mailing Address - Country:US
Mailing Address - Phone:651-254-3669
Mailing Address - Fax:651-254-1519
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:MAIL STOP: 11503L
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-3669
Practice Address - Fax:651-254-1519
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN55662207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine