Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | N5747 | TX |
NPI | 1124010525 |
---|---|
Provider Name | Cherie J Johnson |
First Address | Pharr, TX 78577-1614 |
Second Address | Edinburg, TX 78539-1404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2005 |
Last Update Date | 19/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
212307703 | (05) | TX |