Individual
BRYAN R JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
6716 NW 11TH PL STE 200, GAINESVILLE, FL 32605-4201
(352) 331-9729
(352) 331-0136
Mailing address
6716 NW 11TH PL STE 200, GAINESVILLE, FL 32605-4201
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9110858
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0237411-00
—
FL
01
—
FP1NC
BCBS
FL
01
—
JF178Y
MEDICARE
—
01
—
JG187Z
MEDICARE
—
Enumeration date
01/25/2018
Last updated
03/08/2022
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