Healthcare Provider Details

I. General information

NPI: 1427042852
Provider Name (Legal Business Name): CURTIS JOHNSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 SW 84TH AVE SUITE 101
PLANTATION FL
33324-2754
US

IV. Provider business mailing address

220 SW 84TH AVE SUITE 101
PLANTATION FL
33324-2754
US

V. Phone/Fax

Practice location:
  • Phone: 954-796-0400
  • Fax: 954-753-6673
Mailing address:
  • Phone: 954-796-0400
  • Fax: 954-753-6673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number5815
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: