Individual
MICHAEL A JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 PRUDENTIAL DR, JACKSONVILLE, FL 32207-8202
(904) 396-4369
(904) 346-0864
Mailing address
PO BOX 863640, ORLANDO, FL 32886-3640
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME88037
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000924954C
—
GA
05
—
00924954B
—
GA
05
—
267229400
—
FL
01
—
71168
BC/BS
FL
Enumeration date
03/03/2006
Last updated
05/19/2008
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