Provider Demographics
NPI:1033194907
Name:JOHNSON, ORLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:ORLEY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-0636
Mailing Address - Country:US
Mailing Address - Phone:787-796-3055
Mailing Address - Fax:787-278-2558
Practice Address - Street 1:DORADO DEL MAR SOPPING CENTER
Practice Address - Street 2:UNIT NO. 27
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-0636
Practice Address - Country:US
Practice Address - Phone:787-796-3055
Practice Address - Fax:787-278-2558
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRDO8474Medicare UPIN