Provider Demographics
NPI:1033133194
Name:JOHNSON, JASON LEONARD (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:LEONARD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10600 4TH ST N
Mailing Address - Street 2:APT 201
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-3282
Mailing Address - Country:US
Mailing Address - Phone:727-365-3207
Mailing Address - Fax:
Practice Address - Street 1:10600 4TH ST N
Practice Address - Street 2:APT 201
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-3282
Practice Address - Country:US
Practice Address - Phone:727-365-3207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9347207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine