Provider Demographics
NPI:1760442834
Name:JOHNSON, JOSEPH PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PATRICK
Last Name:JOHNSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 TUSKAWILLA RD STE 221
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5289
Mailing Address - Country:US
Mailing Address - Phone:407-775-5315
Mailing Address - Fax:407-287-6835
Practice Address - Street 1:1425 TUSKAWILLA RD STE 221
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5289
Practice Address - Country:US
Practice Address - Phone:077-755-3154
Practice Address - Fax:407-287-6835
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA065445207Q00000X
IN01054071A207Q00000X
FLME144087207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003118314CMedicaid