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Organization
LAKECREST MEDICAL PLLC
Active
Organization
LAKECREST MEDICAL PLLC
Active
Other names
Weldon Johnson Jr, D.O.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WELDON R JOHNSON JR. D.O. (PHYSICIAN)
(972) 475-1351
Entity
Organization
Contact information
Practice address
7617 LAKEVIEW PKWY, ROWLETT, TX 75088-4356
(972) 475-1351
(972) 412-8220
Mailing address
7617 LAKEVIEW PKWY, ROWLETT, TX 75088-4356
(972) 475-1351
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
H1113
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0919714-01
—
TX
Enumeration date
09/15/2010
Last updated
09/15/2010
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