Provider Demographics
NPI:1760442834
Name:JOHNSON, JOSEPH PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PATRICK
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 1:1506 S FRENCH AVE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-3374
Mailing Address - Country:US
Mailing Address - Phone:321-257-0489
Mailing Address - Fax:321-257-0491
Practice Address - Street 1:1506 S FRENCH AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-3374
Practice Address - Country:US
Practice Address - Phone:321-257-0489
Practice Address - Fax:321-257-0491
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA065445207Q00000X
IN01054071A207Q00000X
FLME144087207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003118314CMedicaid