Provider Demographics
NPI:1225296957
Name:JOHNSON, ELIZABETH BARBARA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:BARBARA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E SUPERIOR ST
Mailing Address - Street 2:STE. L201
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2207
Mailing Address - Country:US
Mailing Address - Phone:218-249-7980
Mailing Address - Fax:218-249-7911
Practice Address - Street 1:1001 E SUPERIOR ST
Practice Address - Street 2:STE. L201
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2207
Practice Address - Country:US
Practice Address - Phone:218-249-7980
Practice Address - Fax:218-249-7911
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN58071208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology