Provider Demographics
NPI:1326061011
Name:JOHNSON, DAVID W (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
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 1:3111 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-2246
Mailing Address - Country:US
Mailing Address - Phone:210-732-7141
Mailing Address - Fax:210-732-5350
Practice Address - Street 1:3111 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-2246
Practice Address - Country:US
Practice Address - Phone:210-732-7141
Practice Address - Fax:210-732-5350
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3185208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPO#130327303Medicaid
TX130327306Medicaid
TXE77725Medicare UPIN