Healthcare Provider Details

I. General information

NPI: 1295899672
Provider Name (Legal Business Name): JEFFREY D JOHNSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 MAIN ST STE 3
MEXICO ME
04257-2603
US

IV. Provider business mailing address

65 LINCOLN AVE, SUITE 1
RUMFORD ME
04276-2104
US

V. Phone/Fax

Practice location:
  • Phone: 207-200-8814
  • Fax: 207-558-8980
Mailing address:
  • Phone: 207-200-8814
  • Fax: 207-558-8980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD1034
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: