Provider Demographics
NPI:1114211299
Name:JOHNSON, MEGAN BROOK (DPM)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:BROOK
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4168 WOODLANDS PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3496
Mailing Address - Country:US
Mailing Address - Phone:813-925-9431
Mailing Address - Fax:
Practice Address - Street 1:4168 WOODLANDS PKWY STE B
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-3496
Practice Address - Country:US
Practice Address - Phone:813-925-9431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3663213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7720870001OtherDMERC
FL480011623OtherRAILROAD MEDICARE
FL33537Medicare PIN