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General NPI Number Information
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NPI Number | 1811913866
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Entity Type | Individual
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Provider Name | PHILIP NATHANIEL JOHNSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 04/30/2024
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Provider Practice Location Address
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Address Line | 2701 W DR MARTIN LUTHER KING JR BLVD
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City | TAMPA
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State | FL
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Zip | 33607-6303
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Country | US
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Telephone | 813-738-6690
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Fax | 813-816-0326
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Provider Business Mailing Address
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Address Line | 2230 SW 19TH AVENUE RD
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City | OCALA
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State | FL
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Zip | 34471-1391
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Country | US
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Telephone | 352-237-4133
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Fax | 352-237-7728
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME66825
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License Number State | FL
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