Provider Demographics
NPI:1295701092
Name:JOHNSON, JANA B (MD)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:B
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:6701 S MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2591
Practice Address - Country:US
Practice Address - Phone:605-322-6960
Practice Address - Fax:605-322-6961
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD5201207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE46022474343Medicaid
MN147L0JOOtherBLUE CROSS
SD0300306OtherMEDICA
SD57108B005OtherWPS TRICARE
SD5900460Medicaid
MN136643200Medicaid
MN147L0JOOtherCC SYSTEMS/ BLUE PLUS
IA0575076Medicaid
SD240793OtherMIDLANDS CHOICE
SD31894OtherSANFORD HEALTH PLAN
SD407211034720OtherPREFERRED ONE
SD4996031OtherBLUE CROSS
SDP00369254OtherRR MEDICARE
SD1908621OtherARAZ/ AMERICA'S PPO
SDHP39293OtherHEALTHPLANS
SD5201OtherDAKOTACARE
MN147L0JOOtherCC SYSTEMS/ BLUE PLUS
NE46022474343Medicaid
SDS41552Medicare PIN