MEDICARE: DR. ANGELA Y ROSS-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
1	173000000X	Legal Medicine	13200	AL
2	207Q00000X	Family Medicine Physician	ME99356	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ME 99356	OTHER	FL	MEDICAL LICENSE NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861492498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA Y ROSS-JOHNSON MD

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 400
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-2051
Country	:	US
Telephone Number	:	305-500-2027
Fax Number	:	305-500-2155

Provider Business Practice Location Address
First Line	:	3854 BRITTON PLZ
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-1406
Country	:	US
Telephone Number	:	813-837-2814
Fax Number	:	813-839-4336

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	12/16/2021

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