Johnson, Marvin Wade

Johnson, Marvin Wade is an sole proprietor health care provider with primary practice located at 850 E Main St Lot 1, Lake Butler FL 32054-1348. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Johnson, Marvin Wade can be contacted via phone (386) 496-2406.

Contact Information

Primary practice address
850 E Main St Lot 1 Lake Butler FL 32054-1348
Phone: (386) 496-2406
Fax: (386) 496-3362
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X ME0011466 Florida

Profile Details

NPI number 1346244092
LBN Legal business name Johnson, Marvin Wade
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 10th, 2005
Last updated Jun 30th, 2010 - about 14 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 1346244092 NPPES
Florida MEDICAID 065935500
Florida Other 53331

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