Provider Demographics
NPI:1437203676
Name:JOHNSON, GERARD SCOT (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:SCOT
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 1:5018 N 10TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2832
Mailing Address - Country:US
Mailing Address - Phone:956-683-9600
Mailing Address - Fax:956-683-9623
Practice Address - Street 1:5110 N 10TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2834
Practice Address - Country:US
Practice Address - Phone:956-631-4444
Practice Address - Fax:956-631-5478
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3477208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111580001Medicaid
TX111580002Medicaid
TX00D643OtherBLUE CROSS BLUE SHIELD
E77549Medicare UPIN