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Organization
MARVIN W. JOHNSON M.D.
Active
Organization
MARVIN W. JOHNSON M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARVIN WADE JOHNSON (MEDICAL DOCTOR)
(386) 496-2406
Entity
Organization
Contact information
Practice address
850 E MAIN ST, LAKE BUTLER, FL 32054-1353
(386) 496-2406
(386) 496-3362
Mailing address
PO BOX 478, LAKE BUTLER, FL 32054-0478
(386) 496-2406
(386) 496-3362
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME0011466
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
065935500
—
FL
01
—
53331
BCBS
FL
Enumeration date
01/31/2017
Last updated
01/31/2017
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