Individual
IAN JAMES JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1381 SOUTH PATRICK DR, PATRICK AFB, 45 MEDICAL GROUP, PATRICK AFB, FL 32925-4162
(321) 494-8152
(321) 494-8533
Mailing address
4066 HIELD RD NW, PALM BAY, FL 32907-6307
(321) 674-0932
(321) 674-6200
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
G0440
TX
Other
Enumeration date
02/06/2006
Last updated
06/25/2009
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