Provider Demographics
NPI:1093085292
Name:VAN A JOHNSON JR MD PLLC
Entity Type:Organization
Organization Name:VAN A JOHNSON JR MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VAN
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:214-924-0245
Mailing Address - Street 1:3430 W WHEATLAND RD
Mailing Address - Street 2:STE 416
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3446
Mailing Address - Country:US
Mailing Address - Phone:972-298-2739
Mailing Address - Fax:972-692-0889
Practice Address - Street 1:3430 W WHEATLAND RD
Practice Address - Street 2:STE 416
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3446
Practice Address - Country:US
Practice Address - Phone:972-298-2739
Practice Address - Fax:972-692-0889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty