Individual
BRIAN T JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD PL
Contact information
Practice address
1805 CYPRESS BROOK DR, SUITE 101, TRINITY, FL 34655-4417
(727) 264-8833
(727) 264-8827
Mailing address
1805 CYPRESS BROOK DR, SUITE 101, TRINITY, FL 34655-4417
(727) 264-8833
(727) 264-8827
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME0057286
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002WH
BLUE CROSS/BLUE SHIELD FLORIDA GROUP ID#
FL
01
—
10230
BLUE CROSS/BLUE SHIELD FLORIDA ID#
FL
01
—
2372307
GHI
—
01
—
DC6458
PROV AND GROUP #
—
01
—
DS2914
PROV AND GROUP #
FL
01
—
P00181819
RAILROAD MEDICARE
FL
01
—
P01014397
RAILROAD MEDICARE
FL
Enumeration date
08/30/2005
Last updated
01/15/2013
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