Provider Demographics
NPI:1902913239
Name:JOHNSON, DAVID LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
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 1:431 S 7TH ST STE 2402
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1801
Mailing Address - Country:US
Mailing Address - Phone:612-332-4864
Mailing Address - Fax:952-831-0530
Practice Address - Street 1:431 S 7TH ST STE 2402
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1801
Practice Address - Country:US
Practice Address - Phone:612-332-4864
Practice Address - Fax:952-831-0530
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG548292084P0800X
MN274562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN112228OtherUCARE
MN15-20048OtherMEDICA/UBH
MN29101JOOtherBC/BS
MN882001OtherPREFERRED ONE
MN315767900Medicaid
MNPSY0215OtherARAZ/AMERICA'S PPO
MN15-20048OtherMEDICA/UBH
MN882001OtherPREFERRED ONE