Healthcare Provider Details

I. General information

NPI: 1255399226
Provider Name (Legal Business Name): THOMAS L JOHNSON II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 08/19/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 W NEWBERRY RD SUITE 1
GAINESVILLE FL
32607-4417
US

IV. Provider business mailing address

4881 NW 8TH AVE SUITE 2
GAINESVILLE FL
32605-4582
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-3502
  • Fax: 352-331-3488
Mailing address:
  • Phone: 352-416-1082
  • Fax: 352-373-6144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME101774
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: