Provider Demographics
NPI:1366491854
Name:JOHNSON-GIEBINK, ROXANNE J (MD)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:J
Last Name:JOHNSON-GIEBINK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 FLORIDA AVE S
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2138
Mailing Address - Country:US
Mailing Address - Phone:321-632-0416
Mailing Address - Fax:321-631-6962
Practice Address - Street 1:1033 FLORIDA AVE S
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2138
Practice Address - Country:US
Practice Address - Phone:321-632-0416
Practice Address - Fax:321-631-6962
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0038373208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0038373OtherLICENSE
FLME0038373OtherLICENSE
FL05442Medicare ID - Type Unspecified