Individual
DR. GLENN RAY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
901 MONTGOMERY ST, DECORAH, IA 52101-2325
(563) 382-2911
(563) 387-3102
Mailing address
2215 BIG TIMBER RD, CALMAR, IA 52132-7577
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
215501
IA
207X00000X
Orthopaedic Surgery Physician
24542
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417950569
—
IA
Enumeration date
05/23/2005
Last updated
01/22/2015
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