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Organization
JOHNNIE R DEGRAW INC
Active
Organization
JOHNNIE R DEGRAW INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNNIE R DEGRAW MD (OWNER)
(352) 794-3872
Entity
Organization
Contact information
Practice address
5915 W GULF TO LAKE HWY, CRYSTAL RIVER, FL 34429-7565
(352) 794-3872
(352) 794-3876
Mailing address
5915 W GULF TO LAKE HWY, CRYSTAL RIVER, FL 34429-7565
(352) 794-3872
(352) 794-3876
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363AM0700X
Medical Physician Assistant
PA2646
FL
363LA2200X
Adult Health Nurse Practitioner
—
—
Other
Enumeration date
03/03/2010
Last updated
10/01/2020
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