Provider Demographics
NPI:1154379568
Name:JOHNSON, RICHARD ARTHUR (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ARTHUR
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 1:820 TURNPIKE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-1229
Mailing Address - Country:US
Mailing Address - Phone:814-765-7502
Mailing Address - Fax:814-765-8807
Practice Address - Street 1:820 TURNPIKE AVE
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-1229
Practice Address - Country:US
Practice Address - Phone:814-765-7502
Practice Address - Fax:814-765-8807
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006446E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011711290001Medicaid
PA430905H54Medicare ID - Type Unspecified
A75986Medicare UPIN