Provider Demographics
NPI:1750464640
Name:JOHNSON, ERIC AUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:AUSTIN
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 1:202 N 24TH AVE E
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-1859
Mailing Address - Country:US
Mailing Address - Phone:320-983-5728
Mailing Address - Fax:218-481-0325
Practice Address - Street 1:202 N 24TH AVE E
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-1859
Practice Address - Country:US
Practice Address - Phone:320-983-5728
Practice Address - Fax:218-481-0325
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN411892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN703522500Medicaid
MN703522500Medicaid
F678740281Medicare ID - Type Unspecified