Provider Demographics
NPI:1386637700
Name:JOHNSON, DONALD CHARLES JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:CHARLES
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 OSCEOLA AVE
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-6638
Mailing Address - Country:US
Mailing Address - Phone:386-672-6424
Mailing Address - Fax:386-672-5251
Practice Address - Street 1:233 OSCEOLA AVE
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-6638
Practice Address - Country:US
Practice Address - Phone:386-672-6424
Practice Address - Fax:386-672-5251
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO-2558213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390314100Medicaid
FL390314100Medicaid
U62367Medicare UPIN