Provider Demographics
NPI:1033114970
Name:JOHNSON, JEFFREY DON (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:DON
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1827
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76804-1827
Mailing Address - Country:US
Mailing Address - Phone:325-641-2655
Mailing Address - Fax:325-641-0992
Practice Address - Street 1:310 S PECOS ST
Practice Address - Street 2:
Practice Address - City:COLEMAN
Practice Address - State:TX
Practice Address - Zip Code:76834-4159
Practice Address - Country:US
Practice Address - Phone:325-793-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX595335367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088844804Medicaid
TX00C44SOtherBCBS GROUP #
TX170450401Medicaid
TX84214UOtherBCBS IND. PROV. #
TX8C7803Medicare PIN