Provider Demographics
NPI:1609021484
Name:JAMES R JOHNSON DO PA
Entity Type:Organization
Organization Name:JAMES R JOHNSON DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCELWANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-596-1815
Mailing Address - Street 1:7332 ROSETREE PL E
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-5703
Mailing Address - Country:US
Mailing Address - Phone:727-397-9140
Mailing Address - Fax:727-593-0002
Practice Address - Street 1:7332 ROSETREE PL E
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-5703
Practice Address - Country:US
Practice Address - Phone:727-397-9140
Practice Address - Fax:727-593-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS00048372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty