Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | K2723 | TX |
N | 208000000X | Pediatrician | K2723 | TX |
N | 2080P0204X | Pediatric Emergency Doctor | K2723 | TX |
NPI | 1326072117 |
---|---|
Provider Name | Laura A Johnson |
First Address | Dallas, TX 75303-1173 |
Second Address | Houston, TX 77030-1501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 08/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
142469904 | (05) | TX |
8K3737 | BCBS (01) | TX |
H27856 | (02) | TX |