Individual
DR. MATTHEW SANDER JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3777 COON RAPIDS BLVD NW, SUITE 100, COON RAPIDS, MN 55433
(763) 421-7420
(763) 592-8453
Mailing address
3777 COON RAPIDS BLVD NW, SUITE 100, COON RAPIDS, MN 55433
(763) 421-7420
(763) 592-8453
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
20373
MN
207W00000X
Ophthalmology Physician
28337
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20373
RESIDENCY PERMIT NUMBER
MN
Enumeration date
08/18/2009
Last updated
07/31/2013
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