Provider Demographics
NPI:1003808346
Name:JOHNSON, CARMEN ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:ELIZABETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3975 I 49 S SERVICE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-0775
Mailing Address - Country:US
Mailing Address - Phone:337-407-2795
Mailing Address - Fax:337-407-2798
Practice Address - Street 1:3975 I 49 S SERVICE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-0775
Practice Address - Country:US
Practice Address - Phone:337-407-2795
Practice Address - Fax:337-407-2798
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13641R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA13641ROtherSTATE LICENSE NUIMBER
LA1434108Medicaid
LA1449687Medicaid
5H947Medicare ID - Type Unspecified
LA1449687Medicaid