Provider Demographics
NPI:1164419693
Name:JOHNSON, CHERYL KAREN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:KAREN
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 1:12121 RICHMOND AVE
Mailing Address - Street 2:SUITE 226
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2432
Mailing Address - Country:US
Mailing Address - Phone:281-597-0991
Mailing Address - Fax:281-597-0470
Practice Address - Street 1:12121 RICHMOND AVE
Practice Address - Street 2:SUITE 226
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2432
Practice Address - Country:US
Practice Address - Phone:281-597-0991
Practice Address - Fax:281-597-0470
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2046207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7621494OtherAETNA
TX125500205Medicaid
TX7621494OtherAETNA
TX322748YK8CMedicare PIN
TXTXB143290Medicare PIN
TX8B4804Medicare PIN