Provider Demographics
NPI:1841209558
Name:JOHNSON, CHRISTINE LYNN (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LYNN
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 1:5161 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9055
Mailing Address - Country:US
Mailing Address - Phone:214-645-2080
Mailing Address - Fax:214-648-9207
Practice Address - Street 1:5161 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9055
Practice Address - Country:US
Practice Address - Phone:214-645-2080
Practice Address - Fax:214-648-9207
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0321208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BR094OtherBCBS
TX047994101Medicaid
TX047994102Medicaid
TX047994102Medicaid
TX047994101Medicaid
TXG89496Medicare UPIN
TX8L3043Medicare PIN
TX70110425Medicare PIN
TX250013230Medicare PIN