Provider Demographics
NPI:1104834456
Name:JOHNSON, RINNA C (MD)
Entity Type:Individual
Prefix:
First Name:RINNA
Middle Name:C
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 1:7832 PAT BOOKER RD.
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-2601
Mailing Address - Country:US
Mailing Address - Phone:210-657-9338
Mailing Address - Fax:210-293-1843
Practice Address - Street 1:7832 PAT BOOKER RD.
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-2601
Practice Address - Country:US
Practice Address - Phone:210-657-9338
Practice Address - Fax:210-293-1843
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4475207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH72807Medicare UPIN
TX8A0874Medicare ID - Type Unspecified