Provider Demographics
NPI:1902032774
Name:JOHNSON, KYLE E SR (MD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:E
Last Name:JOHNSON
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3100 SPRING FOREST RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-2880
Mailing Address - Country:US
Mailing Address - Phone:919-882-0705
Mailing Address - Fax:919-873-9821
Practice Address - Street 1:555 E CHEVES ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2617
Practice Address - Country:US
Practice Address - Phone:843-661-6215
Practice Address - Fax:336-716-6415
Is Sole Proprietor?:No
Enumeration Date:2009-06-06
Last Update Date:2016-12-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC36791207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology