Individual
MARK L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
405 LONDONDERRY DR STE 105, WACO, TX 76712-7920
(254) 776-0266
Mailing address
405 LONDONDERRY DR STE 105, WACO, TX 76712-7920
(254) 776-0266
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G5225
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
131199509
—
TX
Enumeration date
02/22/2006
Last updated
07/11/2023
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