Johnson, Bradley Tyler

Johnson, Bradley Tyler is an individual health care provider with primary practice located at 133 Benmore Dr Ste 100 , Winter Park FL 32792-4111. He recently has only one registered license in Allopathic & Osteopathic Physicians / Otolaryngology, which is considered as his primary health care specialty. Johnson, Bradley Tyler can be contacted via phone (407) 644-4883.

Contact Information

Primary practice address
133 Benmore Dr Ste 100 Winter Park FL 32792-4111
Phone: (407) 644-4883
Fax: (407) 644-3697
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Otolaryngology 207Y00000X ME132490 Florida

Profile Details

NPI number 1003010596
LBN Legal business name Johnson, Bradley Tyler
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 11th, 2007
Last updated Dec 27th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003010596 NPPES
Florida MEDICAID 022744400

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