Provider Demographics
NPI:1144208737
Name:JOHNSON, ANTHONY (DO)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 FANNIN ST STE 700
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-5205
Mailing Address - Country:US
Mailing Address - Phone:832-325-7288
Mailing Address - Fax:713-383-1464
Practice Address - Street 1:6410 FANNIN ST STE 210
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3000
Practice Address - Country:US
Practice Address - Phone:832-325-7288
Practice Address - Fax:713-383-1464
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9384207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183797301Medicaid
TX8L1443Medicare PIN
TX183797301Medicaid
TXTXB117226Medicare PIN
TX8J0254Medicare PIN
TX8J3688Medicare PIN