Provider Demographics
NPI:1497761134
Name:JOHNSON, SCOTT ROGER (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ROGER
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 1:609 O ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:NE
Mailing Address - Zip Code:68818-1100
Mailing Address - Country:US
Mailing Address - Phone:402-694-3191
Mailing Address - Fax:402-694-2146
Practice Address - Street 1:609 O ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:NE
Practice Address - Zip Code:68818-1100
Practice Address - Country:US
Practice Address - Phone:402-694-3191
Practice Address - Fax:402-694-2146
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19902207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE31872OtherBCBS NUMBER
NEG45428Medicare UPIN
NE268596Medicare ID - Type UnspecifiedMEDICARE NUMBER