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General NPI Number Information
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NPI Number | 1902377617
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Entity Type | Individual
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Provider Name | RICHARD JOHNSON MD
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Gender | Male
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Dates
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Enumeration Date | 12/07/2018
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Last Update Date | 12/07/2018
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Provider Practice Location Address
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Address Line | 5333 N DIXIE HWY STE 201
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City | OAKLAND PARK
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State | FL
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Zip | 33334-3454
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Country | US
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Telephone | 954-563-9876
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Fax |
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Provider Business Mailing Address
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Address Line | 38 PORT SIDE DR
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-3008
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Country | US
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Telephone | 954-649-7097
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Fax |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME40905
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License Number State | FL
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