Individual
DR. DEREK RICHARD JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Mailing address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
104357
MN
2084N0400X
Neurology Physician
52256
MN
2084N0400X
Neurology Physician
A99137
CA
2085R0202X
Diagnostic Radiology Physician
Primary
52256
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
IA
05
—
ENROLLED
—
MN
05
—
ENROLLED
—
SD
05
—
ENROLLED
—
WI
01
—
P01111002
RAILROAD MEDICARE
MN
Enumeration date
04/20/2007
Last updated
10/20/2020
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