Healthcare Provider Details

I. General information

NPI: 1366491854
Provider Name (Legal Business Name): ROXANNE J JOHNSON-GIEBINK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 FLORIDA AVE S
ROCKLEDGE FL
32955-2138
US

IV. Provider business mailing address

1033 FLORIDA AVE S
ROCKLEDGE FL
32955-2138
US

V. Phone/Fax

Practice location:
  • Phone: 321-632-0416
  • Fax: 321-631-6962
Mailing address:
  • Phone: 321-632-0416
  • Fax: 321-631-6962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME0038373
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: