Provider Demographics
NPI:1477970713
Name:OTONG, JOHNSON (MD)
Entity type:Individual
Prefix:DR
First Name:JOHNSON
Middle Name:
Last Name:OTONG
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 1:1785 NORTHPOINTE PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-5742
Mailing Address - Country:US
Mailing Address - Phone:813-536-7277
Mailing Address - Fax:833-642-0635
Practice Address - Street 1:6703 38 AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1536
Practice Address - Country:US
Practice Address - Phone:727-213-5377
Practice Address - Fax:727-828-9639
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1650208D00000X, 208D00000X
FLARNP-9340098363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLACN1650OtherFLORIDA MEDICAL LICENSE
FLACN1650OtherFLORIDA MEDICAL LICENSE