Provider Demographics
NPI:1851354815
Name:JOHNSON, DONALD EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:EDWARD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6401 UNIVERSITY AVE NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4341
Mailing Address - Country:US
Mailing Address - Phone:763-572-5710
Mailing Address - Fax:763-571-3008
Practice Address - Street 1:6341 UNIVERSITY AVE NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-4946
Practice Address - Country:US
Practice Address - Phone:763-572-5710
Practice Address - Fax:763-586-5888
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN20360207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN103271OtherUCARE MN
MN0113604OtherMEDICA
MN08046JOOtherBCBS OF MN
MN933080100Medicaid
MN6603885OtherMEDICA UC
MN23227OtherAMERICA'S PPO
MNHP19910OtherHEALTHPARTNERS
MN1000886OtherPREFERRED ONE
MN4044543OtherAETNA
MN103271OtherUCARE MN
MN4044543OtherAETNA
MN08046JOOtherBCBS OF MN