MEDICARE: BRANDI M JOHNSON DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	PO3199	FL
2	213E00000X	Podiatrist	PO3199	FL
3	213ES0131X	Foot Surgery Podiatrist	PO3199	FL
4	213EP1101X	Primary Podiatric Medicine Podiatrist	PO3199	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00420517	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	202703	OTHER	FL	AMERIGROUP
2	65891	OTHER	FL	BCBS
3	PO3199	OTHER	FL	LICENSE NO
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639257207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI M JOHNSON DPM

Provider Business Mailing Address
First Line	:	206 BUCKINGHAM PL
Second Line	:	SUITE 101
City	:	BRANDON
State	:	FL
Zip	:	33511-4910
Country	:	US
Telephone Number	:	813-571-2977
Fax Number	:	813-654-9545

Provider Business Practice Location Address
First Line	:	206 BUCKINGHAM PL
Second Line	:	SUITE 101
City	:	BRANDON
State	:	FL
Zip	:	33511-4910
Country	:	US
Telephone Number	:	813-571-2977
Fax Number	:	813-654-9545

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	02/16/2017

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Directions to “ BRANDI M JOHNSON DPM” Practice Location

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