Individual
JAMES DANIEL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1300 W TERRELL AVE, SUITE 420, FORT WORTH, TX 76104-2820
(817) 784-8268
(817) 336-8034
Mailing address
1300 W TERRELL AVE, SUITE 420, FORT WORTH, TX 76104-2820
(817) 784-8268
(817) 336-8034
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
E1206
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124984905
—
TX
05
—
124984906
—
TX
05
—
124984907
—
TX
01
—
124984908
MEDICAID OTHER
TX
05
—
124984909
—
TX
Enumeration date
09/21/2005
Last updated
06/19/2014
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