Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | N0774 | TX |
N | 208000000X | Pediatrician | 2004009983 | MO |
NPI | 1144270786 |
---|---|
Provider Name | Dr. Maria Suzanne Johnson |
First Address | San Antonio, TX 78207-3154 |
Second Address | San Antonio, TX 78207-3108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 04/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
209128602 | (05) | MO |
I14345 | (02) |