Provider Demographics
NPI:1245238872
Name:JOHNSON, HOUSTON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HOUSTON
Middle Name:
Last Name:JOHNSON
Suffix:JR
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 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4231
Mailing Address - Country:US
Mailing Address - Phone:419-291-7424
Mailing Address - Fax:
Practice Address - Street 1:4447 TALMADGE RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3500
Practice Address - Country:US
Practice Address - Phone:419-472-1632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063487208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
020019926OtherRAILROAD MEDICARE
OH0915246Medicaid
OHJO0722613Medicare PIN
D67127Medicare UPIN
OH0915246Medicaid