Provider Demographics
NPI:1366449357
Name:DR. JENNIFER JOHNSON-CALDWELL, M.D.,P.A.
Entity Type:Organization
Organization Name:DR. JENNIFER JOHNSON-CALDWELL, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LAVETTE
Authorized Official - Last Name:JOHNSON-CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-520-8963
Mailing Address - Street 1:2450 LOUISIANA ST
Mailing Address - Street 2:STE 400716
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-2380
Mailing Address - Country:US
Mailing Address - Phone:713-520-8963
Mailing Address - Fax:713-523-6941
Practice Address - Street 1:1315 ST JOSEPH PKWY
Practice Address - Street 2:STE 140
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8233
Practice Address - Country:US
Practice Address - Phone:713-520-8963
Practice Address - Fax:713-523-6941
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR JENNIFER JOHNSON-CALDWELL MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157180403Medicaid
TX157577101Medicaid