Individual
MITCHELL W JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3770 7TH TER, #101, VERO BEACH, FL 32960-6553
(772) 567-6602
(772) 567-7754
Mailing address
3770 7TH TER, #101, VERO BEACH, FL 32960-6553
(772) 567-6602
(772) 567-7754
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA 2767
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
970009579
RAILROAD MEDICARE PROV#
FL
01
—
Y02C0
BLUE CROSS BLUE SHIELD
FL
Enumeration date
02/07/2006
Last updated
01/26/2010
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