Provider Demographics
NPI:1235139056
Name:JOHNSON, RAY MONROE (MD)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:MONROE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NOLA RUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-6074
Mailing Address - Country:US
Mailing Address - Phone:254-698-6629
Mailing Address - Fax:254-698-1673
Practice Address - Street 1:200 NOLA RUTH BLVD
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-6074
Practice Address - Country:US
Practice Address - Phone:254-698-6628
Practice Address - Fax:254-698-1673
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9098208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85X737Medicare ID - Type Unspecified
TXG55566Medicare UPIN