Johnson, Derek Richard

Johnson, Derek Richard is an individual health care provider with primary practice located at 200 1St St Sw , Rochester MN 55905-0001. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Neurology, Allopathic & Osteopathic Physicians / Diagnostic Radiology. Allopathic & Osteopathic Physicians / Diagnostic Radiology is his primary health care specialty. Johnson, Derek Richard can be contacted via phone (507) 284-2511.

Contact Information

Primary practice address
200 1St St Sw Rochester MN 55905-0001
Phone: (507) 284-2511
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurology 2084N0400X A99137 California
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 104357 Minnesota
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 52256 Minnesota
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 52256 Minnesota

Profile Details

NPI number 1750508453
LBN Legal business name Johnson, Derek Richard
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 20th, 2007
Last updated Oct 20th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750508453 NPPES
Minnesota MEDICAID ENROLLED
Minnesota MEDICAID ENROLLED
Minnesota MEDICAID ENROLLED
Minnesota Other P01111002
Minnesota MEDICAID ENROLLED

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