Organization
COASTAL FOOT & ANKLE WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD W JOHNSON DPM (OWNER)
(904) 826-1900
Entity
Organization
Contact information
Practice address
1740 TREE BLVD STE 112, ST AUGUSTINE, FL 32084-5720
(904) 826-1900
(904) 826-1920
Mailing address
1740 TREE BLVD STE 112, ST AUGUSTINE, FL 32084-5720
(904) 826-1900
(904) 826-1920
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
P02829
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000NU
BCBS OF FLORIDA
FL
Enumeration date
01/19/2010
Last updated
12/27/2020
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