Provider Demographics
NPI:1497859482
Name:JOHNSON, HAROLD V III (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:V
Last Name:JOHNSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 EIGHTH AVE
Mailing Address - Street 2:SUITE #412
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2618
Mailing Address - Country:US
Mailing Address - Phone:817-336-0337
Mailing Address - Fax:817-336-8853
Practice Address - Street 1:800 EIGHTH AVE
Practice Address - Street 2:SUITE #412
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2618
Practice Address - Country:US
Practice Address - Phone:817-336-0337
Practice Address - Fax:817-336-8853
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD5048207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4526152OtherAETNA
TX00N087OtherBLUE CROSS
TX4526152OtherAETNA
TX00N087OtherBLUE CROSS