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DR. JESSE WAYNE JOHNSON M.D.

>> Internal Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1245344571

Individual Registrant:
DR. JESSE WAYNE JOHNSON M.D.
Gender: M
Not Sole Proprietor

Location and contact information for practice:
4106 W LAKE MARY BLVD SUITE 100 LAKE MARY, FL 32746-3315 US
Tel: 407-333-2273  Fax: 407-333-3939

Contact information for business:
4106 W LAKE MARY BLVD SUITE 100 LAKE MARY, FL 32746-3315 US
Tel: 407-333-2273  Fax: 407-333-3939

Registration Information:
NPI: 1245344571
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207R00000XAllopathic & Osteopathic Physicians
Internal Medicine
FLME 49038

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
CIGNA4308871FL01
MEDICARE RRPTAN DN9084FL01
BLUE CROSS BLUE SHIELD04163FL01
AETNA0004104041FL01
MEDICARE PROVIDER TRANSACTION ACCESS NUMBERAM199FL01




HEALTH CARE JOBS FL - Page 1



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