Provider Demographics
NPI:1245226695
Name:JOHNSON, WILLIAM H III (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:JOHNSON
Suffix:III
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 1:1240 W GRANADA BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5915
Mailing Address - Country:US
Mailing Address - Phone:386-236-6854
Mailing Address - Fax:386-263-2996
Practice Address - Street 1:1240 W GRANADA BLVD FL 2
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5915
Practice Address - Country:US
Practice Address - Phone:386-236-6854
Practice Address - Fax:386-263-2996
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME367002086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012903200-GROUPMedicaid
FLDV0492-GROUPOtherRR MEDICARE
FL007WMOtherBLUE SHIELD FLORIDA
FLP01369814-INDIVIDUALOtherRR MEDICARE
FL041690800-INDIVIDUALMedicaid
FLHT021A-GROUPMedicare PIN
FL007WMOtherBLUE SHIELD FLORIDA
FLDV0492-GROUPOtherRR MEDICARE
1245226695OtherNPI
FLPENDINGMedicaid