Provider Demographics
NPI:1972581510
Name:JOHNSON, RODNEY L (MD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:L
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 2467
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68848-2467
Mailing Address - Country:US
Mailing Address - Phone:308-865-2231
Mailing Address - Fax:308-338-1671
Practice Address - Street 1:5308 PARKLANE DRIVE
Practice Address - Street 2:SUITE 4B
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8629
Practice Address - Country:US
Practice Address - Phone:308-865-2231
Practice Address - Fax:308-338-1671
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE164872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
300065033OtherRAILROAD MEDICARE
E41324Medicare UPIN
NENA1200002Medicare PIN