Provider Demographics
NPI:1093739716
Name:JOHNSON, GERALD JERARD (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:JERARD
Last Name:JOHNSON
Suffix:
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 1:5252 W UNIVERSITY DR
Mailing Address - Street 2:ATTN: MKIPCU
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-7822
Mailing Address - Country:US
Mailing Address - Phone:469-764-6950
Mailing Address - Fax:469-764-6954
Practice Address - Street 1:5252 W UNIVERSITY DR
Practice Address - Street 2:ATTN: MKIPCU
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-7822
Practice Address - Country:US
Practice Address - Phone:469-764-6950
Practice Address - Fax:469-764-6954
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3276208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1805921-04Medicaid
TX180592101Medicaid
OK200098530AMedicaid
TX180592101Medicaid
TX8G6481Medicare PIN
TX1805921-04Medicaid