Provider Demographics
NPI:1710326319
Name:WU, JOHNSON (DO)
Entity Type:Individual
Prefix:
First Name:JOHNSON
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:JOHNNY
Other - Middle Name:
Other - Last Name:WU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:4107 SPICEWOOD SPRINGS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8645
Mailing Address - Country:US
Mailing Address - Phone:512-973-3360
Mailing Address - Fax:512-343-7107
Practice Address - Street 1:4107 SPICEWOOD SPRINGS RD STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8645
Practice Address - Country:US
Practice Address - Phone:512-973-3360
Practice Address - Fax:512-343-7107
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1042482624207QH0002X
TXBP10048226207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX421525301Medicaid