Healthcare Provider Details

I. General information

NPI: 1497712384
Provider Name (Legal Business Name): DOUGLAS WILLIAM JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7015 A C SKINNER PKWY BLDG 100
JACKSONVILLE FL
32256-6932
US

IV. Provider business mailing address

PO BOX 19675
JACKSONVILLE FL
32245-9675
US

V. Phone/Fax

Practice location:
  • Phone: 904-516-3737
  • Fax: 904-516-3738
Mailing address:
  • Phone: 904-309-8680
  • Fax: 904-345-5841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME43406
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: