Provider Demographics
NPI:1932116407
Name:JOHNSON, TODD M (DO)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:889 SKYE LN
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1452
Mailing Address - Country:US
Mailing Address - Phone:727-937-5262
Mailing Address - Fax:727-507-3618
Practice Address - Street 1:601 MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-5848
Practice Address - Country:US
Practice Address - Phone:727-734-6141
Practice Address - Fax:727-734-6915
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7647207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G63794Medicare UPIN