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NPI Code Detail

MEDICARE: DR. CHERYL DIANE JOHNSON M.D.

MEDICARE: DR. CHERYL DIANE JOHNSON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208M00000XHospitalist PhysicianME117062FL
2207R00000XInternal Medicine PhysicianME117062FL
3208000000XPediatrics PhysicianME117062FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
24160665OTHERTNBCBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114923414
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHERYL DIANE JOHNSON M.D.
Provider Business Mailing Address
First Line : PO BOX 2147
Second Line :
City : FORT MYERS
State : FL
Zip : 33902-2147
Country : US
Telephone Number : 239-343-2052
Fax Number : 239-343-5348
Provider Business Practice Location Address
First Line : 9981 S HEALTHPARK DR
Second Line :
City : FORT MYERS
State : FL
Zip : 33908-3618
Country : US
Telephone Number : 239-343-2052
Fax Number : 239-343-5348
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2005
Last Update Date : 08/22/2024

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