Edward R Johnson, MD
Individual provider Active NPI Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician · Fargo, ND
NPI 1497715064 · NPPES record last updated Nov 4, 2008
Key facts
- NPI
- 1497715064
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X
- License
- 10858 (ND)
- Practice address
- 3000 32ND Ave S
Fargo, ND 58103-6132 - Phone
- (701) 364-8000
- Fax
- (701) 364-8078
- NPI assigned
- Mar 27, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42197 | MN | MD | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician |
| 10858 | ND | MD | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 208G00000X | 10858 | ND | Yes |
| Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 208G00000X | 42197 | MN |
Addresses
Primary practice location
3000 32ND Ave S
Fargo, ND 58103-6132
Mailing address
PO Box 6001
Fargo, ND 58108-6001
Phone (701) 364-3300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14696 | Medicaid | ND | |
| 968613400 | Medicaid | MN |
Other providers in Fargo, ND
- Cybil Johnson
- Cynthia Johnson
- Daniel David Johnson
- Denise L Johnson
- Donita Jane Johnson
- Eldon A. Johnson
- Elizabeth Johnson
- Ellen Johnson
- Emily Johnson
- Erika Lane Johnson
All providers in Fargo, ND · Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 4, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.