Provider Demographics
NPI:1356448476
Name:JOHNSON, DEAN EVERETT (MD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:EVERETT
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 1:4508 38TH ST
Mailing Address - Street 2:SUITE 128
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-1668
Mailing Address - Country:US
Mailing Address - Phone:402-563-3616
Mailing Address - Fax:402-563-0466
Practice Address - Street 1:4508 38TH ST
Practice Address - Street 2:SUITE 128
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-1668
Practice Address - Country:US
Practice Address - Phone:402-563-3616
Practice Address - Fax:402-563-0466
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15947207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE3886OtherMIDLANDS CHOICE
NE3030OtherBCBS NE
NE47064690800Medicaid
NE095414Medicare ID - Type UnspecifiedMEDICARE
NE47064690800Medicaid