Individual
MR. GARY ALAN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
1716 BRIARCREST DR, STE 800, BRYAN, TX 77802-2763
(979) 846-2878
(979) 846-2877
Mailing address
1716 BRIARCREST DR, STE 800, BRYAN, TX 77802-2763
(979) 846-2878
(979) 846-2877
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1107241
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0041JZ
BCBS OUTPATIENT P.T.
TX
05
—
1639130-01
—
TX
01
—
8T1220
FEDERAL BCBS P.T.
TX
Enumeration date
04/04/2007
Last updated
01/29/2019
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