Provider Demographics
NPI:1790984144
Name:JOHNSON, AARON ELLIOTT (MD)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:ELLIOTT
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:PO BOX 160
Mailing Address - Street 2:515 SOUTH MOORE ST.
Mailing Address - City:BLUE EARTH
Mailing Address - State:MN
Mailing Address - Zip Code:56013
Mailing Address - Country:US
Mailing Address - Phone:507-526-7388
Mailing Address - Fax:507-526-7724
Practice Address - Street 1:515 SOUTH MOORE ST.
Practice Address - Street 2:
Practice Address - City:BLUE EARTH
Practice Address - State:MN
Practice Address - Zip Code:56013
Practice Address - Country:US
Practice Address - Phone:507-526-7388
Practice Address - Fax:507-526-7724
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN52254207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine