Provider Demographics
NPI:1508852666
Name:JOHNSON, CHRISTOPHER CULLEN (MD OBGYN)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:CULLEN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD OBGYN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 498
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:IA
Mailing Address - Zip Code:51566-0498
Mailing Address - Country:US
Mailing Address - Phone:712-623-7000
Mailing Address - Fax:712-623-7224
Practice Address - Street 1:1400 SENATE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:RED OAK
Practice Address - State:IA
Practice Address - Zip Code:51566-1715
Practice Address - Country:US
Practice Address - Phone:712-623-6335
Practice Address - Fax:712-623-3755
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29118207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1226159Medicaid
IA10371Medicare PIN
IAI6310Medicare ID - Type UnspecifiedMEDICARE NUMBER
IAG51663Medicare UPIN