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Dr. Glenn Ray Johnson

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NPI Number Detailed Information

Provider Information:

Name: Dr. Glenn Ray Johnson
Gender: M
Provider License Number If Given: 215501

NPI Information:

NPI: 1417950569
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 5/23/2005

Last Update Date: 1/22/2015

Provider Business Mailing Address:

Address: 2215 BIG TIMBER RD
Calmar, IA 52132
Phone Number:
Fax Number:

Provider Business Practice Location Address:

Address: 901 MONTGOMERY ST
Decorah, IA 52101
Phone Number: 5633822911
Fax Number: 5633873102

Provider Taxonomy:

Primary: 207X00000X
Secondary (if any): 207X00000X
State: IA

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