Individual
DR. DIANNE LAROCHE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3599 UNIVERSITY BLVD. S., BLDG. 300, JACKSONVILLE, FL 32216-0000
(904) 399-5550
(904) 346-4334
Mailing address
3599 UNIVERSITY BLVD. S., BLDG. 300, JACKSONVILLE, FL 32216-0000
(904) 399-5550
(904) 346-4334
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME93196
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109749741A
—
GA
05
—
275351100
—
FL
01
—
P00319147
RAILROAD MEDICARE
GA
Enumeration date
10/29/2005
Last updated
08/21/2017
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