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General NPI Number Information
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NPI Number | 1972181519
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Entity Type | Individual
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Provider Name | RYAN JOHNSON DO
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Gender | Male
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Dates
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Enumeration Date | 04/01/2021
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 2021 PROFESSIONAL CENTER DR STE 100
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City | ORANGE PARK
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State | FL
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Zip | 32073-4461
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Country | US
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Telephone | 49-622-9200
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Fax | 904-622-9188
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Provider Business Mailing Address
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Address Line | 2021 PROFESSIONAL CENTER DR STE 100
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City | ORANGE PARK
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State | FL
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Zip | 32073-4461
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Country | US
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Telephone | 49-622-9200
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Fax | 904-622-9188
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | UO8151
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 56876
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License Number State | FL
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