Johnson, Richard W

Johnson, Richard W is an individual health care provider with primary practice located at 200 Southpark Blvd Ste 208, St Augustine FL 32086-3129. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Johnson, Richard W can be contacted via phone (904) 826-1900.

Contact Information

Primary practice address
200 Southpark Blvd Ste 208 St Augustine FL 32086-3129
Phone: (904) 826-1900
Fax: (904) 826-1920
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X PO2829 Florida

Profile Details

NPI number 1477590248
LBN Legal business name Johnson, Richard W
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 1st, 2006
Last updated Apr 6th, 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 1477590248 NPPES
Florida MEDICAID 340246100
Florida Other 6326530001

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