Individual
MR. JERRY ALLEN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1201 SAM BASS ROAD, ROUND ROCK, TX 78681-4137
(512) 388-1861
(512) 388-0373
Mailing address
1201 SAM BASS ROAD, ROUND ROCK, TX 78681-4137
(512) 388-1861
(512) 388-0373
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00163
TX
363AM0700X
Medical Physician Assistant
PA00163
TX
Other
Enumeration date
10/03/2006
Last updated
09/04/2008
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