Provider Demographics
NPI:1376531889
Name:JOHNSON, ROBERT MARSHALL (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MARSHALL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4763 BARWICK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-1500
Mailing Address - Country:US
Mailing Address - Phone:817-370-2895
Mailing Address - Fax:817-370-6278
Practice Address - Street 1:4763 BARWICK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-1500
Practice Address - Country:US
Practice Address - Phone:817-370-2895
Practice Address - Fax:817-370-6278
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0722213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
00RD16Medicare ID - Type Unspecified
T14062Medicare UPIN