Provider Demographics
NPI:1245380864
Name:JOHNSON, DANA KNIGHT (DO)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:KNIGHT
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:DANE
Other - Middle Name:KNIGHT
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:504 N. CLEVELAND ST.
Mailing Address - Street 2:
Mailing Address - City:MOUNT AYR
Mailing Address - State:IA
Mailing Address - Zip Code:50854-2201
Mailing Address - Country:US
Mailing Address - Phone:641-464-3226
Mailing Address - Fax:641-464-4420
Practice Address - Street 1:504 N. CLEVELAND ST.
Practice Address - Street 2:
Practice Address - City:MOUNT AYR
Practice Address - State:IA
Practice Address - Zip Code:50854-2201
Practice Address - Country:US
Practice Address - Phone:641-464-3226
Practice Address - Fax:641-464-4420
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03071208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIA0104OtherJOHN DEERE
IA58933OtherBLUE CROSS
IA8813OtherMIDLAND CHOICE
IA020036723Medicaid
MO244754206Medicaid
IA0150094Medicaid
IA58933Medicare ID - Type Unspecified
IA020036723Medicaid