Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | L4474 | TX |
N | 2080P0204X | Pediatric Emergency Doctor | L4474 | TX |
NPI | 1205851672 |
---|---|
Provider Name | Frederick C Johnson |
First Address | Dallas, TX 75218-4502 |
Second Address | Dallas, TX 75251-2202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 27/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
164307403 | (05) | TX |
164307404 | (05) | TX |
164307406 | (05) | TX |
23981741 | (05) | NM |
8S2689 | BCBS (01) | TX |