Provider Demographics
NPI:1861769218
Name:IAN TODD JOHNSON MD LLC
Entity type:Organization
Organization Name:IAN TODD JOHNSON MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-495-0087
Mailing Address - Street 1:1447 MEDICAL PARK BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3164
Mailing Address - Country:US
Mailing Address - Phone:561-844-0120
Mailing Address - Fax:561-800-1074
Practice Address - Street 1:4848 COCONUT CREEK PKWY
Practice Address - Street 2:200
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33063-3904
Practice Address - Country:US
Practice Address - Phone:954-764-6116
Practice Address - Fax:954-764-6119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108492207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty