Individual
PAUL M JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
311 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2781
(386) 425-4267
(386) 425-4879
Mailing address
1401 25TH ST S, GREAT FALLS, MT 59405-6010
(406) 731-8888
(406) 731-8876
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
ME160203
FL
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
Primary
ME160203
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000093475
BLUE CROSS
MT
05
—
0058327
—
MT
01
—
080192535
RAILROAD MEDICARE
—
05
—
12219
—
ND
Enumeration date
10/23/2006
Last updated
12/20/2024
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