Provider Demographics
NPI:1730311390
Name:JOHNSON, KEVIN E (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KEVIN
Other - Middle Name:E
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7460 UNIVERSITY BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-8903
Mailing Address - Country:US
Mailing Address - Phone:074-410-8945
Mailing Address - Fax:
Practice Address - Street 1:7460 UNIVERSITY BLVD STE 110
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-8903
Practice Address - Country:US
Practice Address - Phone:074-410-8945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO54419207Q00000X
FLME124826207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO54419OtherCOLORADO MD LICENSE
CO1730311390OtherNPI