Individual
JOHNNY STATON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSA
Contact information
Practice address
1208 PAINTBRUSH ST, MESQUITE, TX 75149
(214) 227-2457
(214) 764-0880
Mailing address
PO BOX 938, ROWLETT, TX 75030-0938
(214) 227-2457
(214) 764-0880
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
SA00687
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SA00687
TEXAS MEDICAL BOARD
TX
Enumeration date
04/01/2017
Last updated
04/25/2019
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