Provider Demographics
NPI:1104800267
Name:JOHNSON, CHRIS J (MD)
Entity type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5520 RIDGEWOOD CV
Mailing Address - Street 2:
Mailing Address - City:MINNETRISTA
Mailing Address - State:MN
Mailing Address - Zip Code:55364-8239
Mailing Address - Country:US
Mailing Address - Phone:612-868-0136
Mailing Address - Fax:952-472-7918
Practice Address - Street 1:5520 RIDGEWOOD CV
Practice Address - Street 2:
Practice Address - City:MINNETRISTA
Practice Address - State:MN
Practice Address - Zip Code:55364-8239
Practice Address - Country:US
Practice Address - Phone:612-868-0136
Practice Address - Fax:952-472-7918
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2011-10-25
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Provider Licenses
StateLicense IDTaxonomies
MN26258207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A94923Medicare UPIN