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Individual

DR. BRADLEY TYLER JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
133 BENMORE DR STE 100, WINTER PARK, FL 32792-4111
(407) 644-4883
(407) 644-3697
Mailing address
133 BENMORE DR STE 100, WINTER PARK, FL 32792-4111
(407) 644-4883
(407) 644-3697

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
ME132490
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
022744400
FL
Enumeration date
06/11/2007
Last updated
12/27/2021
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