Provider Demographics
NPI:1205836632
Name:DONALD E. JOHNSON, MD, PA
Entity Type:Organization
Organization Name:DONALD E. JOHNSON, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-249-9925
Mailing Address - Street 1:16855 NE 2ND AVE
Mailing Address - Street 2:#103
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-1744
Mailing Address - Country:US
Mailing Address - Phone:305-249-9925
Mailing Address - Fax:305-249-8145
Practice Address - Street 1:16855 NE 2ND AVE
Practice Address - Street 2:#103
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-1744
Practice Address - Country:US
Practice Address - Phone:305-249-9925
Practice Address - Fax:305-249-8145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 11465261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD65924Medicare UPIN
FL90747Medicare ID - Type Unspecified