Individual
JACK JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
212 CREEK LOOP RD, BASTROP, TX 78602-3197
(512) 988-6564
Mailing address
212 CREEK LOOP RD, BASTROP, TX 78602-3197
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
02/05/2022
Last updated
02/05/2022
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