Individual
GARY A JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1024 N MAIN ST, RICE LAKE, WI 54868-1236
(715) 234-8151
(715) 234-9750
Mailing address
1024 N MAIN ST, RICE LAKE, WI 54868-1236
(715) 234-8151
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
22411
WI
2085R0202X
Diagnostic Radiology Physician
46214
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
230014100
—
MN
05
—
31559000
—
WI
Enumeration date
12/05/2006
Last updated
03/07/2023
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