Individual
DR. KERRY R JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7777 FOREST LN, DALLAS, TX 75230-2505
(972) 758-3598
Mailing address
PO BOX 201606, DALLAS, TX 75320-1606
(972) 758-3598
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
J5362
TX
208000000X
Pediatrics Physician
Primary
J5362
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
84783F
BCBS
TX
01
—
89931K
BCBS
TX
01
—
8K9072
BCBS
TX
Enumeration date
12/19/2005
Last updated
12/04/2007
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