Provider Demographics
NPI:1720084916
Name:JOHNSON, DARRYL C (DO)
Entity Type:Individual
Prefix:
First Name:DARRYL
Middle Name:C
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 1:1215 DUFF AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-5400
Mailing Address - Country:US
Mailing Address - Phone:515-239-4400
Mailing Address - Fax:
Practice Address - Street 1:1015 DUFF AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-5733
Practice Address - Country:US
Practice Address - Phone:515-239-4414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02790207V00000X
IL036077233207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
035513OtherHEALTH ALLIANCE
40048OtherWELLMARK BC/BS
IA3097246Medicaid
19834OtherIOWA HEALTH SOLUTIONS
IA0139OtherJOHN DEERE HEALTH PLAN
4796890002OtherDMERC
19834OtherIOWA HEALTH SOLUTIONS
I3113Medicare PIN
035513OtherHEALTH ALLIANCE