Provider Demographics
NPI:1376633081
Name:TERRY L. JOHNSON, M.D., P.A.
Entity Type:Organization
Organization Name:TERRY L. JOHNSON, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-696-1600
Mailing Address - Street 1:3506 BUCHANAN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-1856
Mailing Address - Country:US
Mailing Address - Phone:940-696-1600
Mailing Address - Fax:940-696-1665
Practice Address - Street 1:3506 BUCHANAN ST
Practice Address - Street 2:SUITE B
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-1856
Practice Address - Country:US
Practice Address - Phone:940-696-1600
Practice Address - Fax:940-696-1665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty