Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | ME78727 | FL |
NPI | 1174513162 |
---|---|
Provider Name | James Henry Johnson JR. |
First Address | Sarasota, FL 34243-2410 |
Second Address | Sarasota, FL 34243-2410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2005 |
Last Update Date | 22/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
257254100 | (05) | FL |
3447860 | AETNA (01) | |
47108 | BCBS (01) | |
G02478 | (02) |