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DR. JESSE WAYNE JOHNSON M.D.
>> Internal Medicine >> Allopathic & Osteopathic PhysiciansRegistrant NPI Number: 1245344571
Individual Registrant:DR. JESSE WAYNE JOHNSON M.D.
Gender: M
Not Sole Proprietor
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
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
Tel: 407-333-2273 Fax: 407-333-3939
Registration Information:
NPI: 1245344571
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 207R00000X | Allopathic & Osteopathic Physicians Internal Medicine | FL | ME 49038 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| CIGNA | 4308871 | FL | 01 |
| MEDICARE RR | PTAN DN9084 | FL | 01 |
| BLUE CROSS BLUE SHIELD | 04163 | FL | 01 |
| AETNA | 0004104041 | FL | 01 |
| MEDICARE PROVIDER TRANSACTION ACCESS NUMBER | AM199 | FL | 01 |
