Individual
JEFFREY RANDALL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3931 LOUISIANA AVE S, ST LOUIS PARK, MN 55426-5000
(952) 993-3123
(612) 630-8242
Mailing address
3931 LOUISIANA AVE S, ST LOUIS PARK, MN 55426-5000
(952) 993-3123
(612) 630-8242
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
56938
MN
207RP1001X
Pulmonary Disease Physician
Primary
56938
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/14/2008
Last updated
07/23/2019
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