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Individual
DR. EDWARD WALLACE JOHNSON III
Active
Individual
DR. EDWARD WALLACE JOHNSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
23591
MS
207Q00000X
Family Medicine Physician
Primary
338347
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
364829701
—
TX
01
—
75-2616977-029
TRICARE
TX
01
—
8GF799
BCBS
TX
01
—
P01754632
RAIL ROAD MEDICARE
TX
Enumeration date
06/17/2013
Last updated
10/23/2023
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