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Organization
JACK L. JOHNSON JR., M.D., P.A.
Active
Organization
JACK L. JOHNSON JR., M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK L. JOHNSON JR. M.D. (OWNER/PHYSICIAN)
(972) 436-9797
Entity
Organization
Contact information
Practice address
560 W MAIN ST, SUITE 100, LEWISVILLE, TX 75057-3629
(972) 436-9797
(972) 436-9790
Mailing address
560 W MAIN ST, SUITE 100, LEWISVILLE, TX 75057-3629
(972) 436-9797
(972) 436-9790
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
H5576
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0047LP
BCBS
TX
Enumeration date
05/23/2008
Last updated
11/21/2008
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