Provider Demographics
NPI:1821068347
Name:JOHNSON, MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4700 SETON CENTER PKWY
Mailing Address - Street 2:125
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5295
Mailing Address - Country:US
Mailing Address - Phone:512-338-8500
Mailing Address - Fax:512-338-8510
Practice Address - Street 1:4700 SETON CENTER PKWY
Practice Address - Street 2:125
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5295
Practice Address - Country:US
Practice Address - Phone:512-338-8500
Practice Address - Fax:512-338-8510
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXG27302080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine