DR. BRADLEY TYLER JOHNSON MD NPI 1003010596

Otolaryngology in Winter Park, FL

About BRADLEY JOHNSON

Bradley Johnson is a provider in Winter Park, FL. The NPI number assigned to this provider is 1003010596. The practitioner's primary taxonomy code is Otolaryngology (207Y00000X). The provider is registered as an individual and their NPI record was last updated 0 years ago.

NPI1003010596 Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider NameDR. BRADLEY TYLER JOHNSON MD
Provider Location Address133 BENMORE DR STE 100 WINTER PARK, FL 32792 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address133 BENMORE DR STE 100 WINTER PARK, FL 32792 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
GenderMale
NPI Entity TypeIndividual Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Sole Proprietor?No
Is Organization Subpart?N/A Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Enumeration Date06-11-2007 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date12-20-2017 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Business Address

DR. BRADLEY TYLER JOHNSON MD
133 BENMORE DR STE 100
WINTER PARK, FL
ZIP 32792
Phone: (407) 644-4883
Fax: (407) 644-3697
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Mailing Address

DR. BRADLEY TYLER JOHNSON MD
133 BENMORE DR STE 100
WINTER PARK, FL
ZIP 32792
Phone: (407) 644-4883
Fax: (407) 644-3697

Primary Taxonomy

Taxonomy Code207Y00000X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationOtolaryngology
TypeAllopathic & Osteopathic Physicians
License No.ME132490
License StateFL
Taxonomy DescriptionAn otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
022744400MEDICAID (05)FL

Map Location


DR. BRADLEY TYLER JOHNSON MD address is 133 BENMORE DR STE 100 WINTER PARK, FL 32792

Other Providers at the same location


The following provider is registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1790194850 JEFFERY WILSON PA-C
Individual
Physician Assistant133 BENMORE DR STE 100
WINTER PARK, FL 32792