Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | N3764 | TX |
Y | 2080P0204X | Pediatric Emergency Doctor | N3764 | TX |
NPI | 1104911551 |
---|---|
Provider Name | Dr. Christine Lee Johnson |
First Address | San Antonio, TX 78229-5900 |
Second Address | San Antonio, TX 78229-5900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 14/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02641349 | (05) | NY |
205319101 | (05) | TX |
8CC677 | BCBSTX (01) | TX |
I23773 | (02) | NY |