Provider Demographics
NPI:1124010525
Name:JOHNSON, CHERIE J (MD)
Entity Type:Individual
Prefix:
First Name:CHERIE
Middle Name:J
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:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1614
Mailing Address - Country:US
Mailing Address - Phone:956-362-2171
Mailing Address - Fax:956-362-2487
Practice Address - Street 1:2821 MICHAELANGELO DR
Practice Address - Street 2:STE 401
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1404
Practice Address - Country:US
Practice Address - Phone:956-362-2470
Practice Address - Fax:956-362-2487
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5747207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212307703Medicaid
TX261472YNG9Medicare PIN
E51126Medicare UPIN