Individual
EDWARD R JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3000 32ND AVE S, FARGO, ND 58103-6132
(701) 364-8000
(701) 364-8078
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(701) 364-3300
(701) 364-8906
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
10858
ND
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
42197
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14696
—
ND
05
—
968613400
—
MN
Enumeration date
03/27/2006
Last updated
11/04/2008
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