Individual
DR. GARY R JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
320 1ST ST N, WINTER HAVEN, FL 33881-4113
(863) 508-0202
(863) 293-4994
Mailing address
PO BOX 2797, WINTER HAVEN, FL 33883
(863) 508-0202
(863) 293-4994
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
ME36696
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
042162600
—
FL
01
—
060063442
RAILROAD MEDICARE
FL
01
—
53792
BCBS
FL
Enumeration date
03/24/2006
Last updated
01/10/2012
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