1255631909 NPI number — CRAIG D. JOHNSON, M.D., P.A.

Table of content: (NPI 1255631909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255631909 NPI number — CRAIG D. JOHNSON, M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRAIG D. JOHNSON, M.D., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1255631909
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6560 FANNIN ST
Provider Second Line Business Mailing Address:
SUITE 1625
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77030-2761
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-791-1800
Provider Business Mailing Address Fax Number:
713-791-1502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6560 FANNIN ST
Provider Second Line Business Practice Location Address:
SUITE 1625
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-2761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-791-1800
Provider Business Practice Location Address Fax Number:
713-791-1502
Provider Enumeration Date:
10/28/2010

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
713-791-1800

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  D9191 , 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: 064999501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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