Provider Demographics
NPI:1366854309
Name:JOHNSON, ERIC DUANE (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DUANE
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 1:1211 E ARMY POST RD
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50315-5957
Mailing Address - Country:US
Mailing Address - Phone:515-256-9540
Mailing Address - Fax:515-256-9600
Practice Address - Street 1:1211 E ARMY POST RD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315-5957
Practice Address - Country:US
Practice Address - Phone:515-256-9540
Practice Address - Fax:515-256-9600
Is Sole Proprietor?:No
Enumeration Date:2014-05-26
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-04759207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine