Provider Demographics
NPI:1295368405
Name:JOHNSON, JOSHUA ALEX
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ALEX
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-6739
Mailing Address - Country:US
Mailing Address - Phone:972-804-8124
Mailing Address - Fax:
Practice Address - Street 1:1701 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-6739
Practice Address - Country:US
Practice Address - Phone:972-804-8124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-16
Last Update Date:2020-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program