Provider Demographics
NPI:1144438052
Name:JOHNSON, ERIC T (DO)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:T
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:204 GLENN ST SE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IA
Mailing Address - Zip Code:52314-1501
Mailing Address - Country:US
Mailing Address - Phone:319-895-8442
Mailing Address - Fax:319-895-8482
Practice Address - Street 1:204 GLENN ST SE
Practice Address - Street 2:SUITE 2
Practice Address - City:MOUNT VERNON
Practice Address - State:IA
Practice Address - Zip Code:52314-1501
Practice Address - Country:US
Practice Address - Phone:319-895-8442
Practice Address - Fax:319-895-8482
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2010-06-29
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Provider Licenses
StateLicense IDTaxonomies
IA37832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry