Individual
BRAD L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2 TAMPA GENERAL CIR, TAMPA, FL 33606-3603
(813) 974-2201
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
ME69430
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28979
BLUE CROSS BLUE SHIELD
FL
05
—
379635300
—
FL
Enumeration date
08/13/2006
Last updated
03/31/2021
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