Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 11753 | CA |
N | 207Q00000X | Family Doctor | 64114 | GA |
N | 207Q00000X | Family Doctor | DO157957 | OR |
Y | 207Q00000X | Family Doctor | OS10896 | FL |
N | 207Q00000X | Family Doctor | UO 1962 | FL |
NPI | 1588828982 |
---|---|
Provider Name | Dr. Jeffery W Johns |
First Address | Fort Myers, FL 33902-2147 |
Second Address | Fort Myers, FL 33907-1317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2008 |
Last Update Date | 30/04/2015 |