Individual
FREDERICK C JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
12221 MERIT DR, SUITE 1610, DALLAS, TX 75251-2202
(214) 217-1911
Mailing address
7914 ENCLAVE WAY, DALLAS, TX 75218-4502
(214) 263-1445
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
L4474
TX
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
L4474
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164307403
—
TX
05
—
164307404
—
TX
05
—
164307406
—
TX
05
—
23981741
—
NM
01
—
8S2689
BCBS
TX
Enumeration date
07/13/2006
Last updated
08/27/2013
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