Provider Demographics
NPI:1245226695
Name:JOHNSON, WILLIAM H III (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:JOHNSON
Suffix:III
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 1:588 STERTHAUS DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5128
Mailing Address - Country:US
Mailing Address - Phone:386-672-9503
Mailing Address - Fax:386-672-0386
Practice Address - Street 1:588 STERTHAUS DR
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5128
Practice Address - Country:US
Practice Address - Phone:386-672-9503
Practice Address - Fax:386-672-0386
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36700208G00000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012903200-GROUPMedicaid
FLDV0492-GROUPOtherRR MEDICARE
FL041690800-INDIVIDUALMedicaid
FLP01369814-INDIVIDUALOtherRR MEDICARE
FL007WMOtherBLUE SHIELD FLORIDA
FLHT021A-GROUPMedicare PIN
FL007WMOtherBLUE SHIELD FLORIDA
FLDV0492-GROUPOtherRR MEDICARE
1245226695OtherNPI
FLPENDINGMedicaid