Provider Demographics
NPI:1730492034
Name:ANITRA JOHNSON MD PA
Entity Type:Organization
Organization Name:ANITRA JOHNSON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANITRA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-557-0300
Mailing Address - Street 1:251 MEDICAL CENTER BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4242
Mailing Address - Country:US
Mailing Address - Phone:281-557-0300
Mailing Address - Fax:281-557-3301
Practice Address - Street 1:251 MEDICAL CENTER BLVD STE 300
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4242
Practice Address - Country:US
Practice Address - Phone:281-557-0300
Practice Address - Fax:281-557-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty