Provider Demographics
NPI:1487666814
Name:JOHNSON, TODD E (DO)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:E
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 1:8055 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 1:5000 N 26TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-4749
Practice Address - Country:US
Practice Address - Phone:402-435-5300
Practice Address - Fax:402-435-5511
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE352207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE01242OtherBCBS - SEPN
01-04472OtherUHC
NE01285OtherBCBS - LINC CARE
NE240451OtherMIDLAND'S CHOICE
NE07-00997OtherUHC
NE470780857 10Medicaid
NE01285OtherBCBS - LINC CARE
NE07-00997OtherUHC
NE240451OtherMIDLAND'S CHOICE
278869Medicare PIN
277016Medicare PIN