Provider Demographics
NPI:1962708495
Name:JOHNSON, MATTHEW DAVID (AP)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DAVID
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8091 MARITIME FLAG ST
Mailing Address - Street 2:9101
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-5575
Mailing Address - Country:US
Mailing Address - Phone:407-217-2609
Mailing Address - Fax:407-644-4370
Practice Address - Street 1:1201 LOUISIANA AVE
Practice Address - Street 2:SUITE E
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2340
Practice Address - Country:US
Practice Address - Phone:407-644-2990
Practice Address - Fax:407-644-4370
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2933171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist