Individual ProviderRichard E JohnsonPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address1000 E 1st St, Ste 400, Duluth, MN 55805-2297(218) 722-5513PECOS EnrollmentBased on the most recent information from CMS, provider Richard E Johnson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1679579429Provider TypeIndividualFull NameJohnson, Richard ECredentialP.A.GenderMaleEnumeration Date6/27/2005Last Updated7/8/2007Contact InformationPractice LocationPractice Address1000 E 1st St, Ste 400, Duluth, MN 55805-2297Phone(218) 722-5513Fax(218) 722-6515Mailing LocationMailing Address1000 E 1st St, Ste 400, Duluth, MN 55805-2297Phone(218) 722-5513Fax(218) 722-6515Provider TaxonomiesCodeDescriptionLicenseCode363AS0400XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense8860MinnesotaProvider IdentifiersIDDescriptionIssuerID73A56J0DescriptionOtherIssuerBLUE SHIELDMinnesotaID983271008414DescriptionOtherIssuerPREFERREDONEMinnesota