Individual
MARC THOMAS JOHANNSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
OS15809
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113776200
—
FL
01
—
CEFLH
BCBS
FL
01
—
PB211
MEDICARE PTAN OHRI
FL
01
—
PS103
MEDICARE PTAN OHMG
FL
Enumeration date
06/11/2008
Last updated
03/28/2023
Update your record
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