MEDICARE: BRIAN T. JOHNSON M.D. PL

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	207N00000X	Dermatology Physician	ME0057286	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01014397	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	002WH	OTHER	FL	BLUE CROSS/BLUE SHIELD FLORIDA GROUP ID#
3	DS2914	OTHER	FL	PROV AND GROUP #
4	10230	OTHER	FL	BLUE CROSS/BLUE SHIELD FLORIDA ID #
5	2372307	OTHER		GHI
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548538630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIAN T. JOHNSON M.D. PL

Provider Business Mailing Address
First Line	:	1805 CYPRESS BROOK DR
Second Line	:	SUITE 101
City	:	TRINITY
State	:	FL
Zip	:	34655-4417
Country	:	US
Telephone Number	:	727-264-8833
Fax Number	:	727-264-8827

Provider Business Practice Location Address
First Line	:	1805 CYPRESS BROOK DR
Second Line	:	SUITE 101
City	:	TRINITY
State	:	FL
Zip	:	34655-4417
Country	:	US
Telephone Number	:	727-264-8833
Fax Number	:	727-264-8827

Authorized Official
Title or Position	:	M.D.
Name	:	DR. BRIAN T JOHNSON
Credential	:	M.D.
Telephone Number	:	727-815-9878

Provider Enumeration Date	:	12/05/2011
Last Update Date	:	01/15/2013

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