Healthcare Provider Details

I. General information

NPI: 1336725019
Provider Name (Legal Business Name): ERIC JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE
LEXINGTON KY
40536-0284
US

IV. Provider business mailing address

5301 S CONGRESS AVE
ATLANTIS FL
33462-1149
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-3253
  • Fax:
Mailing address:
  • Phone: 561-548-1711
  • Fax: 561-548-1743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberTP106
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: