Provider Demographics
NPI:1528089174
Name:JOHNSON, ERIC M (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8055 O ST
Mailing Address - Street 2:STE 300
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2580
Mailing Address - Country:US
Mailing Address - Phone:402-421-0896
Mailing Address - Fax:402-421-0945
Practice Address - Street 1:1240 ARIES DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-9100
Practice Address - Country:US
Practice Address - Phone:402-420-1300
Practice Address - Fax:402-420-1326
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21189207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE30511OtherBCBS - LINC CARE
NE100249469 00Medicaid
01-05784OtherUHC - LINC CARE
NE03055OtherBCBS - SEPN
NE01-06679OtherUHC - SEPN
NE12369OtherMIDLAND'S CHOICE
NE30511OtherBCBS - LINC CARE
P00333785Medicare PIN
NE01-06679OtherUHC - SEPN
01-05784OtherUHC - LINC CARE
NE280401Medicare PIN