Provider Demographics
NPI:1003050279
Name:JOHNSON, DEBORAH GAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:GAIL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:JOHNSON
Other - Last Name:GRIEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:200 S 10TH ST
Mailing Address - Street 2:SUITE 1105
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-4800
Mailing Address - Country:US
Mailing Address - Phone:956-682-7938
Mailing Address - Fax:956-682-5645
Practice Address - Street 1:200 S 10TH ST
Practice Address - Street 2:SUITE 1105
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-4800
Practice Address - Country:US
Practice Address - Phone:956-682-7938
Practice Address - Fax:956-682-5645
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0137207ZF0201X
KS04-26402207ZF0201X
CO31617207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COG79195Medicare UPIN