Provider Demographics
NPI:1174513162
Name:JOHNSON, JAMES HENRY JR (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:HENRY
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2852 UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2410
Mailing Address - Country:US
Mailing Address - Phone:941-351-9777
Mailing Address - Fax:941-351-9975
Practice Address - Street 1:2852 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2410
Practice Address - Country:US
Practice Address - Phone:941-351-9777
Practice Address - Fax:941-351-9975
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME787272084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3447860OtherAETNA
FL257254100Medicaid
47108OtherBCBS
3447860OtherAETNA
K5188Medicare ID - Type Unspecified