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NPI Code Detail

MEDICARE: REBECCA LOU JOHNSON MD

MEDICARE:   REBECCA LOU JOHNSON  MD
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
1207P00000XEmergency Medicine PhysicianME71741FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
114162OTHERFLBLUE CROSS OF FLORIDA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437231677
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA LOU JOHNSON MD
Provider Business Mailing Address
First Line : FLORIDA GULF COAST UNIVERSITY
Second Line : 10501 FGCU BLVD. SOUTH
City : FORT MYERS
State : FL
Zip : 33965-0001
Country : US
Telephone Number : 239-590-7966
Fax Number :
Provider Business Practice Location Address
First Line : FLORIDA GULF COAST UNIVERSITY
Second Line : 10501 FGCU BLVD. SOUTH
City : FORT MYERS
State : FL
Zip : 33965-0001
Country : US
Telephone Number : 239-590-7966
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2006
Last Update Date : 12/31/2012

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