Provider Demographics
NPI:1518939974
Name:JOHNSON, JAMES FRED (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:FRED
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 1:2301 25TH ST S
Mailing Address - Street 2:SUITE I
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103
Mailing Address - Country:US
Mailing Address - Phone:701-241-9300
Mailing Address - Fax:701-235-4525
Practice Address - Street 1:2301 25TH ST S
Practice Address - Street 2:SUITE I
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103
Practice Address - Country:US
Practice Address - Phone:701-241-9300
Practice Address - Fax:701-235-4525
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3782207X00000X
MN31925207X00000X
SD5131207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14183Medicaid
SD0023210OtherWELLMARK BCBS
MN58A11JOOtherMN BCBS
594741014527OtherPREFERRED ONE COMMUNITY HEALTH
MN840563800Medicaid
HP19542OtherHEALTH PARTNERS
NDJOH23210OtherBCBS ND
0900489OtherMEDICA
200026912OtherRR MEDICARE
SD6402130Medicaid
SD0023210OtherWELLMARK BCBS
200026912OtherRR MEDICARE
D25997Medicare UPIN
0900489OtherMEDICA