Mitchell W Johnson, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA 2767 Issued in FL

Practice address

3770 7TH Ter
#101
Vero Beach, FL 32960-6553

Phone

(772) 567-6602

Fax

(772) 567-7754

NPI assigned

Feb 7, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1264464000000",
    "number": "1205809746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3770 7TH TER",
            "address_2": "#101",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329606553",
            "telephone_number": "772-567-6602",
            "fax_number": "772-567-7754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3770 7TH TER",
            "address_2": "#101",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329606553",
            "telephone_number": "772-567-6602",
            "fax_number": "772-567-7754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MITCHELL",
        "middle_name": "W",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-07",
        "last_updated": "2010-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA 2767",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PROV#",
            "identifier": "970009579",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "Y02C0",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jenifer Rene Johnson
• Jimmy Dylan Johnson, D.M.D.
• Kenneth Ian Johnson, MD
• Laura Lynn Johnson, M.D.
• Melissa Erin Johnson, P.T.
• Ryan Maurice Johnson, MD
• Sherry Danielle Johnson, APRN
• Thomas B Johnson, MD
• Kendra Johnston, MSW
• Kimberli S Johnston, PA-C

• Surgical Physician Assistant in Vero Beach, FL
• Providers in Vero Beach, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.