Provider Demographics
NPI:1659389575
Name:SISON LIMSENBEN, JOHANNA S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:S
Last Name:SISON LIMSENBEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 CLARA BARTON BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5738
Mailing Address - Country:US
Mailing Address - Phone:972-272-7887
Mailing Address - Fax:972-272-7992
Practice Address - Street 1:601 CLARA BARTON BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5738
Practice Address - Country:US
Practice Address - Phone:972-272-7887
Practice Address - Fax:972-272-7992
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3382208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156634101Medicaid
TX156634101Medicaid
TX8A4042Medicare ID - Type Unspecified