Individual
TIMOTHY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1301 W FRANK AVE, LUFKIN, TX 75904-3305
(936) 633-2758
Mailing address
2602 TULANE DR, LUFKIN, TX 75901-7246
(936) 637-1439
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA02448
TX
Other
Enumeration date
07/31/2006
Last updated
07/08/2007
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