Individual
DR. STEPHEN JOHNS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1340 BROAD AVE, STE 450, GULFPORT, MS 39501-2404
(228) 865-1453
(228) 865-1457
Mailing address
PO BOX 1810, GULFPORT, MS 39502-1810
(228) 868-6486
(228) 865-9523
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
11374
MS
208100000X
Physical Medicine & Rehabilitation Physician
Primary
11374
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00114017
—
MS
01
—
080069404
RAILROAD MEDICARE
MS
Enumeration date
08/20/2006
Last updated
10/26/2022
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