Provider Demographics
NPI:1053577015
Name:JOHNSON, KEYNE K (MD)
Entity type:Individual
Prefix:DR
First Name:KEYNE
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N LAKEMONT AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3200
Mailing Address - Country:US
Mailing Address - Phone:407-255-2152
Mailing Address - Fax:407-246-8395
Practice Address - Street 1:201 N LAKEMONT AVE STE 500
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3200
Practice Address - Country:US
Practice Address - Phone:407-255-2152
Practice Address - Fax:407-246-8395
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102412207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCQ334YMedicare PIN
FLCQ334ZMedicare PIN