MEDICARE: JRJ PODIATRY INC

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	213E00000X	Podiatrist	PO2654	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083610638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JRJ PODIATRY INC

Provider Business Mailing Address
First Line	:	4000 N STATE ROAD 7
Second Line	:	STE 412
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33319-4882
Country	:	US
Telephone Number	:	954-731-0028
Fax Number	:	954-731-0288

Provider Business Practice Location Address
First Line	:	4000 N STATE ROAD 7
Second Line	:	STE 412
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33319-4882
Country	:	US
Telephone Number	:	954-731-0028
Fax Number	:	954-731-0288

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. JEANETTE R JOHNSON
Credential	:	DPM
Telephone Number	:	954-731-0028

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	12/29/2008

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