Provider Demographics
NPI:1659474567
Name:JOHNSON, GERHARD JACOB (MD)
Entity Type:Individual
Prefix:DR
First Name:GERHARD
Middle Name:JACOB
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1 VETERANS DRIVE
Mailing Address - Street 2:111E
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419
Mailing Address - Country:US
Mailing Address - Phone:612-467-4135
Mailing Address - Fax:612-725-2149
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:111E
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-467-4135
Practice Address - Fax:612-725-2149
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN16266207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology