Provider Demographics
NPI:1508019779
Name:JOHNSON, ERIC MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MATTHEW
Last Name:JOHNSON
Suffix:
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 1:150 TAMIAMI TRL N STE 1
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-6215
Mailing Address - Country:US
Mailing Address - Phone:239-331-8551
Mailing Address - Fax:
Practice Address - Street 1:24 MILES CENTER WAY
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4067
Practice Address - Country:US
Practice Address - Phone:207-661-2018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35098080207X00000X, 207XX0005X
MEMD22477207X00000X, 207XX0005X
FLME135286207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH54961Medicaid
OHHO36060Medicare PIN