Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | PO-2558 | FL |
N | 213ES0103X | Foot & Ankle Surgery | PO-2558 | FL |
NPI | 1386637700 |
---|---|
Provider Name | Dr. Donald Charles Johnson JR. |
First Address | Ormond Beach, FL 32176-6638 |
Second Address | Ormond Beach, FL 32176-6638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2005 |
Last Update Date | 23/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
390314100 | (05) | FL |
U62367 | (02) |