Individual
LARRY D JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3614 OCEAN DR., CORPUS CHRISTI, TX 78411-1343
(361) 549-1758
(281) 784-1555
Mailing address
3614 OCEAN DR., CORPUS CHRISTI, TX 78411-1343
(361) 549-1758
(281) 784-1555
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
F3186
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053309252
TRICARE SOUTH
TX
05
—
140034325
—
TX
01
—
8P5507
BCBS PROVIDER NUMBER
TX
Enumeration date
10/11/2005
Last updated
12/21/2021
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