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1134787518
JAKE MICHAEL JOHNSON
BRIDGEPORT, CT
NPI
1134787518
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: CT 4557)
Enumeration Date
2019-05-31
Last Update Date
2019-08-07
Business Address
JAKE MICHAEL JOHNSON PA
267 GRANT ST
BRIDGEPORT, CT 06610-2805
Phone number: 203-384-3000
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Mailing Address
JAKE MICHAEL JOHNSON PA
21 VISTA DR
SHELTON, CT 06484-1696
Phone number: 203-814-7810
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