MEDICARE: DAVID ALBERT 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
1	207W00000X	Ophthalmology Physician	17100	FL

General Provider Information

NPI Number	:	1366603938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ALBERT JOHNSON M.D.

Provider Business Mailing Address
First Line	:	3225 S MACDILL AVE
Second Line	:	SUITE 129-258
City	:	TAMPA
State	:	FL
Zip	:	33629-8171
Country	:	US
Telephone Number	:	813-334-8368
Fax Number	:

Provider Business Practice Location Address
First Line	:	3225 S MACDILL AVE
Second Line	:	SUITE 129-258
City	:	TAMPA
State	:	FL
Zip	:	33629-8171
Country	:	US
Telephone Number	:	813-334-8368
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2008
Last Update Date	:	06/17/2008

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