Provider Demographics
NPI:1588828982
Name:JOHNS, JEFFERY W (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:W
Last Name:JOHNS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JEFFERY
Other - Middle Name:W
Other - Last Name:JOHNS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-1449
Mailing Address - Fax:239-424-1421
Practice Address - Street 1:4771 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1317
Practice Address - Country:US
Practice Address - Phone:239-343-9800
Practice Address - Fax:239-343-9848
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO 1962207Q00000X
FLOS10896207Q00000X
GA64114207Q00000X
CA11753204D00000X
ORDO157957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM