Provider Demographics
NPI:1073930111
Name:JOHNSON, ELIZABETH RAINOLD RAFFERTY (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RAINOLD RAFFERTY
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 1:2450 FONDREN RD STE 310
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-2324
Mailing Address - Country:US
Mailing Address - Phone:713-781-7907
Mailing Address - Fax:
Practice Address - Street 1:2450 FONDREN RD STE 310
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-2324
Practice Address - Country:US
Practice Address - Phone:713-781-7907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXR0881208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program