Provider Demographics
NPI:1356399455
Name:JOHNSON, ROBERT A (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 E WASHINGTON ROW
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-2609
Mailing Address - Country:US
Mailing Address - Phone:419-217-3329
Mailing Address - Fax:
Practice Address - Street 1:167 E WASHINGTON ROW
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-2609
Practice Address - Country:US
Practice Address - Phone:419-217-3329
Practice Address - Fax:567-214-4101
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.0066768208000000X
OH34.006768208000000X
NC200400526208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89136UKMedicaid
NV100505267Medicaid