Provider Demographics
NPI:1902856479
Name:JOHNSON, TODD C (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:C
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 1:2241 PEGGY LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5732
Mailing Address - Country:US
Mailing Address - Phone:972-276-0536
Mailing Address - Fax:972-276-6037
Practice Address - Street 1:2241 PEGGY LN
Practice Address - Street 2:SUITE A
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5732
Practice Address - Country:US
Practice Address - Phone:972-276-0536
Practice Address - Fax:972-276-6037
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9116207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84592YOtherBCBS
TX8562J2Medicare ID - Type Unspecified
TX84592YOtherBCBS