Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | F4124 | TX |
Y | 111NI0900X | Internist | F4124 | TX |
N | 207RI0200X | Infectious Disease | F4124 | TX |
NPI | 1063430445 |
---|---|
Provider Name | Philip C Johnson III |
First Address | Dallas, TX 75303-1448 |
Second Address | Houston, TX 77030-3000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 08/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
134462404 | (05) | TX |
81411J | BCBS (01) | TX |
C17518 | (02) | TX |