Provider Demographics
NPI:1497824767
Name:PEGGY JOHNSON DO PA
Entity Type:Organization
Organization Name:PEGGY JOHNSON DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:ARLENE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:361-883-9688
Mailing Address - Street 1:PO BOX 270900
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78427-0900
Mailing Address - Country:US
Mailing Address - Phone:361-883-9688
Mailing Address - Fax:361-992-3458
Practice Address - Street 1:5801 PATTON STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2458
Practice Address - Country:US
Practice Address - Phone:361-883-9688
Practice Address - Fax:361-992-3458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7431261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
I34022Medicare UPIN
00X572Medicare PIN