Individual
GARY N JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
900 E BROADWAY AVE, BISMARCK, ND 58501-4520
(701) 530-6500
Mailing address
PO BOX 997, BISMARCK, ND 58502-0997
(701) 530-6500
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
4094
ND
207LP2900X
Pain Medicine (Anesthesiology) Physician
4094
ND
208VP0000X
Pain Medicine Physician
Primary
4094
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1452790
—
ND
01
—
P00227623
RAILROAD MEDICARE
ND
Enumeration date
01/22/2007
Last updated
07/22/2016
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