Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 1940 | TX |
NPI | 1013236256 |
---|---|
Provider Name | Dr. Alicia Lenise Johnson |
First Address | Missouri City, TX 77489-2486 |
Second Address | Richmond, TX 77469-3230 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2010 |
Last Update Date | 06/11/2013 |