| Marvin W. Johnson M.D. | |
|
850 E Main St Lake Butler FL 32054-1353 | |
| (386) 496-2406 | |
| (386) 496-3362 |
| Full Name | Marvin W. Johnson M.D. |
|---|---|
| Speciality | Family Medicine |
| Location | 850 E Main St, Lake Butler, Florida |
| Authorized Official Name and Position | Marvin Wade Johnson (MEDICAL DOCTOR) |
| Authorized Official Contact | 3864962406 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Marvin W. Johnson M.D. Po Box 478 Lake Butler FL 32054-0478 Ph: (386) 496-2406 | Marvin W. Johnson M.D. 850 E Main St Lake Butler FL 32054-1353 Ph: (386) 496-2406 |
| NPI Number | 1265979041 |
|---|---|
| Provider Enumeration Date | 01/31/2017 |
| Last Update Date | 01/31/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265979041 | NPI | - | NPPES |
| 53331 | Other | FL | BCBS |
| 065935500 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME0011466 (Florida) | Primary |
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