Healthcare Provider Details

I. General information

NPI: 1093793614
Provider Name (Legal Business Name): RONALD F JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RICK F JOHNSON

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MAR WALT DR FT WALTON BEACH ANESTHESIA LLC
FT WALTON BEACH FL
32547-6708
US

IV. Provider business mailing address

8201 UNIVERSITY PKWY FT WALTON BEACH ANESTHESIA LLC
PENSACOLA FL
32514-4904
US

V. Phone/Fax

Practice location:
  • Phone: 850-474-8100
  • Fax: 850-474-8083
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME0070884
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: