Provider Demographics
NPI:1871577726
Name:JOHNSON, DAVID LUGENE (PA-C)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LUGENE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 S 173RD CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-1415
Mailing Address - Country:US
Mailing Address - Phone:402-895-6348
Mailing Address - Fax:
Practice Address - Street 1:4239 FARNAM ST STE 409
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2803
Practice Address - Country:US
Practice Address - Phone:402-552-2500
Practice Address - Fax:402-552-2720
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE199363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant