Provider Demographics
NPI:1346291846
Name:JOHNSON, DAVID PAUL (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PAUL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 KENYON ROAD
Mailing Address - Street 2:STE A PHYSICIAN'S OFFICE BLDG, WEST
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:51501-5742
Mailing Address - Country:US
Mailing Address - Phone:515-574-6120
Mailing Address - Fax:515-574-6135
Practice Address - Street 1:804 KENYON ROAD
Practice Address - Street 2:STE A PHYSICIAN'S OFFICE BLDG, WEST
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:51501-5742
Practice Address - Country:US
Practice Address - Phone:515-574-6120
Practice Address - Fax:515-574-6135
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00665103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA10207OtherBLUE CROSS BLUE SHIELD
IA10207OtherBLUE CROSS BLUE SHIELD