MEDICARE: DR. DOUGLAS L JOHNSON DMD

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	2082S0099X	Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician	DN15568	FL
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN15568	FL
3	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	DN15568	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00237430	OTHER	FL	RAILROAD MEDICARE INDIVIDUAL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1615570	OTHER		UNITED CONCORDIA
2	000415568	OTHER	FL	DELTA DENTAL OF FLORIDA
3	84009	OTHER	FL	BCBS INS
4	B15568-1	OTHER	FL	FL HEALTH KIDS
6	20-0618977	OTHER		SOUTHCARE MEDICAL PPO
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730292517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS L JOHNSON DMD

Provider Business Mailing Address
First Line	:	PO BOX 7870
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72766-7870
Country	:	US
Telephone Number	:	479-464-5824
Fax Number	:	479-725-2395

Provider Business Practice Location Address
First Line	:	1301 PLANTATION ISLAND DR S STE 101
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32080-3109
Country	:	US
Telephone Number	:	904-439-7980
Fax Number	:	904-460-0506

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	05/29/2026

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