Provider Demographics
NPI:1124133533
Name:JOHNSON, RICK (DO)
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 WILDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-3610
Mailing Address - Country:US
Mailing Address - Phone:785-473-7060
Mailing Address - Fax:785-263-3979
Practice Address - Street 1:2317 WILDWOOD LN
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-3610
Practice Address - Country:US
Practice Address - Phone:785-473-7060
Practice Address - Fax:785-263-3979
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-21868207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100235990AMedicaid
481176488OtherTAX ID
KS040648OtherBLUE CROSS BLUE SHIELD