Provider Demographics
NPI:1326498999
Name:JOHNSON, JUSTIN (DO)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S CLIFF AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-5275
Mailing Address - Country:US
Mailing Address - Phone:605-339-0002
Mailing Address - Fax:605-335-3505
Practice Address - Street 1:601 S CLIFF AVE STE A
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-5275
Practice Address - Country:US
Practice Address - Phone:605-339-0002
Practice Address - Fax:605-335-3505
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD12829207L00000X
KYR4455207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty