Individual
BRUCE E JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1008 FIRST COLONIAL RD, SUITE 103, VIRGINIA BEACH, VA 23454-3071
(757) 481-2515
(757) 481-4064
Mailing address
PO BOX 7068, PORTSMOUTH, VA 23707-0068
(757) 686-3508
(757) 686-0541
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
0101033614
VA
207RP1001X
Pulmonary Disease Physician
Primary
0101033614
VA
207RS0012X
Sleep Medicine (Internal Medicine) Physician
0101033614
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0601762003
CIGNA
VA
01
—
325089
BC/BS
VA
05
—
5819229
—
VA
01
—
V29930786
CHAMPUS
VA
Enumeration date
09/22/2006
Last updated
01/06/2012
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