Provider Demographics
NPI:1366836603
Name:JOHNSON, ABBY COLDREN (MD)
Entity Type:Individual
Prefix:DR
First Name:ABBY
Middle Name:COLDREN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ABBY
Other - Middle Name:CAMILLE
Other - Last Name:COLDREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:700 NORTH SAM HOUSTON PARKWAY WEST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77067
Mailing Address - Country:US
Mailing Address - Phone:832-828-1005
Mailing Address - Fax:832-825-9461
Practice Address - Street 1:1 BAYLOR PLZ # BCM320
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:832-824-1173
Practice Address - Fax:832-825-9302
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXR4987208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program