Johnson, Kenneth Ian
Johnson, Kenneth Ian is an sole proprietor health care provider with primary practice located at 1700 Se Hillmoor Dr Ste 501 , Port St Lucie FL 34952. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Johnson, Kenneth Ian can be contacted via phone (772) 212-7049.Contact Information
Primary practice address
1700 Se Hillmoor Dr Ste 501
Port St Lucie FL 34952
Phone: (772) 212-7049
Fax: (772) 212-7059
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | ME73635 | Florida |
Profile Details
| NPI number | 1457349508 |
|---|---|
| LBN Legal business name | Johnson, Kenneth Ian |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 12th, 2005 |
| Last updated | Jun 28th, 2018 - about 6 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1457349508 | NPPES |
| Florida | Other | 80193338 | RAILROAD |
| Florida | Other | ME73635 | RAILROAD |
| Florida | Other | 578869751 | RAILROAD |
| Florida | Other | BCBS | RAILROAD |
| Florida | Other | ME73635 | RAILROAD |
| Florida | Other | ME73635 | RAILROAD |
| Florida | MEDICAID | 258874900 | RAILROAD |
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