Healthcare Provider Details

I. General information

NPI: 1558637272
Provider Name (Legal Business Name): ERIC SCOTT JOHNSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E SAMPLE ROAD
POMPANO BEACH FL
33064
US

IV. Provider business mailing address

2800 E COMMERCIAL BLVD STE 102
FORT LAUDERDALE FL
33308-4202
US

V. Phone/Fax

Practice location:
  • Phone: 954-941-8300
  • Fax:
Mailing address:
  • Phone: 954-491-0900
  • Fax: 954-491-1306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOS15340
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberOS15340
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS15340
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: