MEDICARE: MISS DOREEN LYNN JOHNSON PA-C, MPH

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	363AM0700X	Medical Physician Assistant	PA9102545	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	:	1194883199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DOREEN LYNN JOHNSON PA-C, MPH

Provider Business Mailing Address
First Line	:	263 LAKE MONTEREY CIR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-8443
Country	:	US
Telephone Number	:	954-608-6352
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 N CONGRESS AVE
Second Line	:	SUITE 113-A
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-3444
Country	:	US
Telephone Number	:	561-381-9979
Fax Number	:	561-381-9989

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	05/26/2011

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