Provider Demographics
NPI:1821076225
Name:JOHNSON, BEENA M (MD)
Entity Type:Individual
Prefix:MRS
First Name:BEENA
Middle Name:M
Last Name:JOHNSON
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 1:920 MEDICAL PLAZA DR
Mailing Address - Street 2:STE 530
Mailing Address - City:WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3204
Mailing Address - Country:US
Mailing Address - Phone:281-825-4900
Mailing Address - Fax:281-825-4904
Practice Address - Street 1:920 MEDICAL PLAZA DR
Practice Address - Street 2:STE 530
Practice Address - City:WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3204
Practice Address - Country:US
Practice Address - Phone:281-825-4900
Practice Address - Fax:281-825-4904
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6001207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG66241Medicare UPIN
TX89071NMedicare ID - Type Unspecified