Provider Demographics
NPI:1033191739
Name:JOHNSON, JOE E JR (MD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:E
Last Name:JOHNSON
Suffix:JR
Gender:M
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:PO BOX 1855
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-1855
Mailing Address - Country:US
Mailing Address - Phone:985-893-9251
Mailing Address - Fax:985-892-7893
Practice Address - Street 1:5001 HIGHWAY 190 EAST SERVICE RD
Practice Address - Street 2:SUITE A3
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-4930
Practice Address - Country:US
Practice Address - Phone:985-893-9251
Practice Address - Fax:985-892-7893
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019902207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00230927OtherRAILROAD MEDICARE
LA1970930Medicaid
LA5R839Medicare PIN
LAP00230927OtherRAILROAD MEDICARE