Individual
KELLY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2489 DIPLOMAT PKWY E, CAPE CORAL, FL 33909-5422
(239) 652-1800
Mailing address
2489 DIPLOMAT PKWY E, CAPE CORAL, FL 33909-5422
(239) 652-1800
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
ME139549
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME139549
DEPARTMENT OF HEALTH
FL
Enumeration date
04/30/2014
Last updated
09/05/2023
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