MEDICARE: ROBERT RAY JOHNSON JR. 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	207Q00000X	Family Medicine Physician	009400085	NC

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982780722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT RAY JOHNSON JR. MD

Provider Business Mailing Address
First Line	:	1333 S DICKINSON DR UNIT 140
Second Line	:
City	:	LELAND
State	:	NC
Zip	:	28451-6434
Country	:	US
Telephone Number	:	910-371-0404
Fax Number	:	910-341-3321

Provider Business Practice Location Address
First Line	:	1333 S DICKINSON DR UNIT 140
Second Line	:
City	:	LELAND
State	:	NC
Zip	:	28451-6434
Country	:	US
Telephone Number	:	910-371-0404
Fax Number	:	910-341-3321

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	07/16/2014

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