Individual
GREGORY CALVIN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDHS
Contact information
Practice address
2307 W MAPLE ST STE B, PORT O CONNOR, TX 77982-2205
(361) 983-2617
Mailing address
2307 W MAPLE ST STE B, PORT O CONNOR, TX 77982-2205
(361) 983-2617
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
09/27/2021
Last updated
09/27/2021
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