Individual
MICHAEL R JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6800 NW 9TH BLVD STE 4, GAINESVILLE, FL 32605-4253
(352) 332-0902
Mailing address
529 NW 60TH ST, GAINESVILLE, FL 32607-2008
(352) 331-5100
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
ME 88411
FL
2084P0800X
Psychiatry Physician
Primary
ME88411
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03008
BLUE CROSS / BLUE SHIELD
FL
Enumeration date
08/21/2006
Last updated
02/10/2022
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