Provider Demographics
NPI:1013236256
Name:JOHNSON, ALICIA LENISE (DPM)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:LENISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15311 TRINITY MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-2486
Mailing Address - Country:US
Mailing Address - Phone:917-664-7929
Mailing Address - Fax:
Practice Address - Street 1:1601 MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3230
Practice Address - Country:US
Practice Address - Phone:281-342-8700
Practice Address - Fax:832-363-3438
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1940213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery