Provider Demographics
NPI:1891798682
Name:JOHNSON, WILLIAM KENT (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KENT
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11221 KATY FWY STE 115
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-2105
Mailing Address - Country:US
Mailing Address - Phone:281-888-1464
Mailing Address - Fax:
Practice Address - Street 1:11221 KATY FWY STE 115
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-2105
Practice Address - Country:US
Practice Address - Phone:281-888-1464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH63202085R0202X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096817404Medicaid
TXP000662G2Medicaid
TX096817403Medicaid
TX096817404Medicaid
TXP000662G2Medicaid
TXF61598Medicare UPIN
TX096817403Medicaid