# JERRY L JOHNSON MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174824510
- **Authorized official:** DR. JERRY L JOHNSON MD (MD/OWNER)
- **Authorized official phone:** (936) 632-1533

## Contact information

- **Practice address:** 503 S JOHN REDDITT DR, LUFKIN, TX 75904-3120
- **Practice address phone:** (936) 632-1533
- **Practice address fax:** (936) 632-1726
- **Mailing address:** 503 S JOHN REDDITT DR, LUFKIN, TX 75904-3120
- **Mailing address phone:** (936) 632-1533
- **Mailing address fax:** (936) 632-1726

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | J2117 | TX | Yes |

## Other

- **Enumeration date:** 11/16/2010
- **Last updated:** 09/06/2012