1851328306 NPI number — RICHARD HENRY JOHNIGAN III MD

Table of content: RICHARD HENRY JOHNIGAN III MD (NPI 1851328306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851328306 NPI number — RICHARD HENRY JOHNIGAN III MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNIGAN
Provider First Name:
RICHARD
Provider Middle Name:
HENRY
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851328306
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10740 N GESSNER DR
Provider Second Line Business Mailing Address:
STE 310
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77064-1240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-897-0416
Provider Business Mailing Address Fax Number:
281-890-8908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10970 SHADOW CREEK PARKWAY
Provider Second Line Business Practice Location Address:
STE 360
Provider Business Practice Location Address City Name:
PEARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77584-0123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-436-8071
Provider Business Practice Location Address Fax Number:
713-436-4030
Provider Enumeration Date:
06/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  L9265 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 185344202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 185344201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2907608 . This is a "BEECHSTREET" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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