Provider Demographics
NPI:1043650641
Name:JOHNSON, JOHN ANDREW JR (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANDREW
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:244 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02675-1757
Mailing Address - Country:US
Mailing Address - Phone:508-362-0099
Mailing Address - Fax:
Practice Address - Street 1:244 WILLOW ST
Practice Address - Street 2:
Practice Address - City:YARMOUTH PORT
Practice Address - State:MA
Practice Address - Zip Code:02675-1757
Practice Address - Country:US
Practice Address - Phone:508-362-0099
Practice Address - Fax:508-362-8811
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA255876207R00000X
MA266075207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine