Individual
REBECCA LOU JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
FLORIDA GULF COAST UNIVERSITY, 10501 FGCU BLVD. SOUTH, FORT MYERS, FL 33965-0001
(239) 590-7966
Mailing address
FLORIDA GULF COAST UNIVERSITY, 10501 FGCU BLVD. SOUTH, FORT MYERS, FL 33965-0001
(239) 590-7966
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME71741
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14162
BLUE CROSS OF FLORIDA
FL
05
—
257876000
—
FL
Enumeration date
10/19/2006
Last updated
12/31/2012
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