Individual
LARRY E JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 2ND AVE NE, JAMESTOWN, ND 58401-3373
(701) 251-6000
(701) 323-5709
Mailing address
PO BOX 2168, FARGO, ND 58107-2168
(701) 234-2119
(701) 234-2045
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4560
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14317
—
ND
Enumeration date
08/31/2006
Last updated
05/08/2013
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