Provider Demographics
NPI:1144206731
Name:JOHNSON, RICHARD B JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:703 HILL COUNTRY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-6159
Mailing Address - Country:US
Mailing Address - Phone:830-257-5500
Mailing Address - Fax:830-257-5501
Practice Address - Street 1:703 HILL COUNTRY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-6159
Practice Address - Country:US
Practice Address - Phone:830-257-5500
Practice Address - Fax:830-257-5501
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF1686207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0399156-01Medicaid
TX00W442Medicare PIN
TXD73354Medicare UPIN