Healthcare Provider Details

I. General information

NPI: 1922134592
Provider Name (Legal Business Name): MATTHEW JULIUS JOHNSON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 11/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 ARLINGTON ST SUITE 400
SARASOTA FL
34239-3507
US

IV. Provider business mailing address

1950 ARLINGTON ST SUITE 400
SARASOTA FL
34239-3507
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-4250
  • Fax: 941-917-4257
Mailing address:
  • Phone: 941-917-4250
  • Fax: 941-917-4257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPAT9104073
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: