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Individual
DR. JESSE WAYNE JOHNSON JR.
Active
Individual
DR. JESSE WAYNE JOHNSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME 49038
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004104041
AETNA
FL
01
—
04163
BLUE CROSS BLUE SHIELD
FL
01
—
4308871
CIGNA
FL
01
—
AM199
MEDICARE PROVIDER TRANSACTION ACCESS NUMBER
FL
01
—
PTAN DN9084
MEDICARE RR
FL
Enumeration date
08/17/2006
Last updated
03/30/2015
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