MEDICARE: DR. JASON LEONARD JOHNSON DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	OS9347	FL

General Provider Information

NPI Number	:	1033133194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON LEONARD JOHNSON DO

Provider Business Mailing Address
First Line	:	10600 4TH ST N
Second Line	:	APT 201
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33716-3282
Country	:	US
Telephone Number	:	727-365-3207
Fax Number	:

Provider Business Practice Location Address
First Line	:	10600 4TH ST N
Second Line	:	APT 201
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33716-3282
Country	:	US
Telephone Number	:	727-365-3207
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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