Provider Demographics
NPI:1437211232
Name:JOHNSON, PAUL RYAN (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RYAN
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 1:1108 1ST ST SE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-3440
Mailing Address - Country:US
Mailing Address - Phone:320-631-2200
Mailing Address - Fax:320-632-3728
Practice Address - Street 1:1108 1ST ST SE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3440
Practice Address - Country:US
Practice Address - Phone:320-631-2200
Practice Address - Fax:320-632-3728
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006019877207X00000X
MN53039207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1437211232Medicaid
MN200002953Medicare PIN
MN1437211232Medicaid
MN1437211232Medicare UPIN