Provider Demographics
NPI:1497726608
Name:JOHNSON, SETH T (DO)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:T
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:411 MAITLAND AVE
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5448
Mailing Address - Country:US
Mailing Address - Phone:321-207-0002
Mailing Address - Fax:321-207-0003
Practice Address - Street 1:411 MAITLAND AVE
Practice Address - Street 2:SUITE 1002
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5448
Practice Address - Country:US
Practice Address - Phone:321-207-0002
Practice Address - Fax:321-207-0003
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2010-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS0005330207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C68470Medicare UPIN