Individual
JAKE MICHAEL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
267 GRANT ST, BRIDGEPORT, CT 06610-2805
(203) 384-3000
Mailing address
21 VISTA DR, SHELTON, CT 06484-1696
(203) 814-7810
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4557
CT
Other
Enumeration date
05/31/2019
Last updated
08/07/2019
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