=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033238415
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIAN T. JOHNSON, MD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2007
-----------------------------------------------------
Last Update Date | 05/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5341 GRAND BLVD STE 102
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34652-4011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-815-9878
-----------------------------------------------------
Fax | 727-848-7967
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5341 GRAND BLVD STE 102
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34652-4011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-815-9878
-----------------------------------------------------
Fax | 727-848-7967
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BRIAN T JOHNSON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 727-815-9878
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------