Individual
MR. JERRY L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
503 S JOHN REDDITT DR, LUFKIN, TX 75904-3120
(936) 632-1533
(936) 632-1726
Mailing address
503 SOUTH JOHN REDDITT, LUFKIN, TX 75904
(936) 634-6636
(936) 632-1726
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
J2117
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
099143202
—
TX
Enumeration date
11/29/2006
Last updated
04/19/2022
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