Organization
RICHARD E JOHNSON, DO, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD E JOHNSON DO (PRESIDENT)
(814) 375-4466
Entity
Organization
Contact information
Practice address
90 BEAVER DR, STE 122-D, DU BOIS, PA 15801-2440
(814) 375-4466
(814) 375-4468
Mailing address
90 BEAVER DR, STE 122-D, DU BOIS, PA 15801-2440
(814) 375-4466
(814) 375-4468
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
OS006605L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011749710002
—
PA
01
—
109685
MEDICARE-UNSPECIFIED
PA
01
—
1421725
UNITED MINE WORKERS
—
01
—
1943373
PA BLUE SHIELD
PA
01
—
DF7290
RAILROAD MEDICARE
—
Enumeration date
03/14/2007
Last updated
10/30/2007
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